Remote Falls Medication Review Service: Impact on Falls in Care Homes
Abstract
Introduction
Immedicare, a digitally-enabled, round-the-clock NHS clinical service provides remote support to care homes nationwide, with approximately a quarter of clinical consultations pertaining to falls.Falls in older people are often multifactorial, with medication being a significant modifiable risk factor.
In July 2024, Immedicare’s pharmacy team launched a targeted, remote falls medication review service (FMRS) to support residents who had fallen and were prescribed at least one medicine identified as contributing to falls, according to the STOPPFall tool (Seppala et al, A&A, 2021).
Method
The FMRS involved a comprehensive review of available medical records and consultation with care homes. Following each review, patient centred medication recommendations were sent to primary care teams. Three months after advice was issued, medical records were re- examined to assess whether recommendations were actioned and determine outcomes, including number of falls before and after the advice was actioned. The first 250 reviews following the service launch were analysed.
Results
Of the 250 patient-centred Falls medication reviews completed, medical records showed that recommendations were followed for 146 residents (58.4%). Ninety-five residents (38%) had medication stopped and/or reduced. For those residents, the average number of falls reported to Immedicare dropped from 2.3 in the two months before to 0.8 in the two months after the medication change. In comparison, those who continued their medication the mean number of falls decreased from 1.9 to 1.1 over the same time.
The difference between the two groups was statistically significant, where medication was stopped or reduced the fall rate over the next two months decreased for 46% of residents (RR 0.54, 95% CI 0.32–0.90, p=0.018).
Conclusion
The FMRS suggests that a remote targeted, patient-centred medication intervention can reduce fall rates in care home residents. Further evaluation with longer follow-up and broader data collection is warranted to substantiate these findings.
Comments
Feedback
This was a nice read and very much ties into a small project we worked on which looked into frequency of falls and anticholinergic burden. Again it showed how medication interventions which are targeted can reduce fall rates and care homes.
Great Poster
Thank you for this very interesting work. Medication review is a key component of falls prevention in care home residents, and it is encouraging to see a patient-centred, pharmacist-led intervention implemented in routine clinical practice.
I have one question regarding the interpretation of the results. Since the decision to implement the medication recommendations was made by the primary care team rather than randomly assigned, how did you account for potential selection bias or confounding? For example, could the residents whose medication was stopped or reduced have differed in terms of frailty, comorbidity, or clinical complexity from those whose medication remained unchanged, thereby influencing the observed reduction in falls?