Implementation of pharmacist falls clinic recommendations in primary care

Introduction

A multidisciplinary falls clinic was established where patients are reviewed by a nurse, physiotherapist, and pharmacist and interventions made to reduce the risk of falls. The pharmacist conducts a structured medication review and fracture risk assessment (FRAX) and provides recommendations to the patient and their GP. The aim of this project was to evaluate the number and type of recommendations made by the pharmacist and whether they are implemented in general practice.

Method

Patients were included if they attended the falls clinic between 1/1/24 and 1/7/24. Data on recommendations were collected from clinic letters sent to GPs. GP connect and patient letters were used to ascertain if recommendations were implemented. Data collected included demographics, number of medication recommendations stratified by type, number of non-medication recommendations e.g. DEXA scans and referrals.

Results

There were 97 eligible patients (67% female), the median age was 79 (IQR 9) years. In total, 255 recommendations were made (mean 2.6 per patient). 79% (n= 202) were medication changes, of these 41% (n=83) were initiating and 39% (n=79) stopping medications, 20% (n=40) recommended dose changes to current medications. Twenty DEXA scans were requested. Non-medication recommendations (excluding DEXA scans) made up 13% (n=33) of recommendations including referrals to other clinics, blood pressure checks and compression stockings. Most recommendations (71%, n=144) were implemented in primary care. The median implementation time was 25 (IQR 39) days.

Conclusions

Pharmacists make a substantial number of recommendations in the specialist falls clinic and most are implemented by the GP but this can take time. Further work is needed to understand when recommendations are not implemented and whether independent prescribing could be used to facilitate faster implementation. We would also like to evaluate whether interventions made in clinic reduce the risk of further falls.