Integrating CGA principles and acute clinical assessment into pharmacist-led care home service: A Feasibility Study

Introduction

Falls, hospital admissions, and reduced quality of life (QoL) are common among care home residents with dementia. Polypharmacy increases these risks, particularly in those with frailty. Current models of care often lack structured medication review and pharmacist-led reviews rarely include clinical assessment.  We assessed the feasibility of a prescribing pharmacist with advanced clinical skills delivering holistic structured medication review alongside acute clinical care in a care home setting.

Methods

Single-group before-and-after feasibility study in a Glasgow care home, Scotland. Residents aged ≥65 years with polypharmacy and acute clinical change were identified by staff and recruited. The pharmacist provided weekly clinical examinations, prescribing, and deprescribing. Joint primary outcomes (recruitment, intervention delivery, data completeness) followed guidance for complex intervention testing. Secondary outcomes: falls, health-related QoL (EQ-5D-5L), unscheduled care contacts, and prescribing changes. Falls were assessed 3 months pre- and post-intervention; other outcomes at baseline and 3 months post-intervention (unscheduled care at 6 months).

Results

Thirty-one participants (52% female, median age 79, mean Rockwood 7) were recruited. Baseline: 39% had ≥1 fall; mean 10 medicines; 77% prescribed antipsychotics. All received the intervention (77 clinical examinations) and completed 3-month follow-up; 25 completed 6-month follow-up. Feasibility criteria were met. Falls reduced by 70% (30 to 9); mobility dimension of EQ-5D-5L improved by 33%; unscheduled care contacts were unchanged. There were 43 prescribing and 71 deprescribing episodes; total medicines reduced by 12%, anticholinergic burden by 14%, antipsychotic prescribing by 21%.

Conclusion

Pharmacist-led holistic care combining clinical assessment and structured medication review is feasible and may reduce falls and improve QoL. A pilot randomised controlled trial is warranted to confirm progression criteria for a definitive trial.