Establishing the knowledge and confidence of hospital pharmacists in medicines optimisation for older people

Introduction:

Polypharmacy, commonly defined as the use of ≥5 medicines, is highly prevalent among adults aged 65 years and older and is associated with adverse events, hospitalisation and increased treatment burden, particularly in those living with frailty. Medicines optimisation (MO) in older adults is a key priority within the LTHT Frailty Strategy. Pharmacists play a central role in multidisciplinary efforts to reduce inappropriate polypharmacy; however, little is known about hospital pharmacists’ confidence in delivering MO for this population.

Methods:

A survey containing Likert-scale questions was developed to assess pharmacists’ confidence across key domains of medicines optimisation in older adults. The survey was hosted on Microsoft Forms and distributed to all LTHT clinical pharmacists via email and during face-to-face team meetings.

Results:

Fifty-six pharmacists responded (40 female, 16 male), representing a range of practice levels from trainee to advanced clinical pharmacist. Respondents worked across Older People’s Medicine (OPM), other medical specialties, surgery, and cancer services. Overall, 86% reported that at least 25% of their caseload comprised patients aged over 65 years. Confidence varied between specialties. Pharmacists working in OPM reported high confidence (≥75% agreeing or strongly agreeing) in reviewing medicines to prevent delirium and in deprescribing medicines with limited benefit or potential harm. Lower confidence (≤50% agreeing or strongly agreeing) was reported in these domains by pharmacists working in surgery and cancer services. Confidence in reviewing medicines to prevent falls was highest among OPM pharmacists (100% agreeing or strongly agreeing), moderate among those working in surgery and other medical specialties (>50%), and lowest in cancer services (≤50%).

Conclusion:

Hospital pharmacists’ confidence in key aspects of medicines optimisation for older adults varies across specialties despite most pharmacists caring for significant numbers of older patients. These findings identify opportunities for targeted education and support to improve confidence in medicines optimisation and deprescribing.