The evaluation of the knowledge and confidence of hospital pharmacists in optimising medicines for older people

Background: Polypharmacy, often defined as the use of ≥5 medicines, is common in older people (OP). It increases the risk of inappropriate prescribing, which is associated with adverse health outcomes, including medication side-effects and hospitalisation. Medicines optimisation (MO) in OP is key to improving healthcare. This study aims to evaluate the knowledge and confidence of hospital pharmacists (including trainees) at MSEFT, in optimising medicines for OP.

Method: A structured survey incorporating Likert-scale items was co-developed, to assess hospital pharmacists’ confidence, in undertaking a range of MO activities for OP. The survey was administered via Microsoft Forms and distributed to 120 pharmacists via email, with face-to-face and Microsoft Teams message prompts.

Results: Forty-seven participants completed the survey (response rate = 39%), representing a range of specialist areas. Participants had varying levels of experience: ranging from <1 to ≥15 years post-qualification. 47% reported that at least half of the patients they cared for, were aged ≥ 65 years.

Confidence differed depending on the MO domains. High confidence (≥ 70% agree/ strongly agree) was reported in identifying medicines requiring caution in OP (85%), adjusting doses appropriately (70%), and reviewing medicines in the context of falls prevention (74%). Lower confidence levels (>50% agree/ strongly agree) were reported for some other MO domains, for example, in deprescribing medicines in patients with poor prognosis (45%), deprescribing medicines which cause harm in OP (47%), and optimising or deprescribing medicines where conditions were over-treated or targets were no longer clinically appropriate (45%).

Conclusion: A substantial proportion of hospital pharmacists regularly care for OP and reported high confidence in many aspects of MO. However, confidence was lower when making and acting on more complex deprescribing and individualised treatment decisions. These findings highlight opportunities for clinical support and training, to improve pharmacists' confidence in optimising medicines for OP.