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Title: The Care Home Independent Prescribing Pharmacist Study (CHIPPS)-A non-randomised feasibility study of independent pharmacist prescribing in care homes
Authors: Inch, J
Notman, F
Bond, C
Aldred, D
Antony, A
Blyth, A
Daffu-O'Reilly, A
Ford, J
Hughes, C
Maskrey, V
Millar, A
Myint, P
Poland, F
Shepstone, L
Zermansky, A
Holland, R
Wright, D
First Published: 2019
Publisher: BMC (part of Springer Nature)
Citation: Pilot and Feasibility Studies, 2019, In Press
Abstract: Background Residents in care homes are often very frail, have complex medicine regimens and are at high risk of adverse drug events. It has been recommended that one healthcare professional should assume responsibility for their medicines management. We propose that this could be a pharmacist independent prescriber (PIP). This feasibility study aimed to test and refine the service specification and proposed study processes to inform the design and outcome measures of a definitive randomised controlled trial to examine the clinical and cost effectiveness of PIPs working in care homes compared to usual care. Specific objectives included: testing processes for participant identification, recruitment, and consent and assessing retention rates; determining suitability of outcome measures, and data collection processes from care homes and GP practices to inform selection of a primary outcome measure; assessing service and research acceptability; testing and refining the service specification. Methods Mixed methods (routine data, questionnaires and focus groups/interviews) were used in this non27 randomised open feasibility study of a 3-month PIP intervention in care homes for older people. Data were collected at baseline and 3 months. One PIP, trained in service delivery, one GP practice and up to three care homes were recruited at each of four UK locations. For ten eligible residents (≥65 years, on at least one regular medication) in each home, the PIP undertook management of medicines, repeat prescription authorisation, referral to other healthcare professionals and staff training. Outcomes (falls, medications, residents quality of life and activities of daily living, mental state and adverse events), were described at baseline and follow-up and assessed for inclusion in the main study. Participants’ views post-intervention were captured in audio-recorded focus groups and semi6 structured interviews. Transcripts were thematically analysed. Results Across the four locations, 44 GP practices, and 16 PIPs expressed interest in taking part; all care homes invited agreed to take part. Two-thirds of residents approached consented to participate (53/86). Forty residents were recruited (mean age 84 years; 61% (24) were female), and 38 participants remained at 3 months (two died). All GP practices, PIPs, and care homes were retained. The number of falls per participating resident was selected as the primary outcome, following assessment of the different outcome measures against pre-determined criteria. The chosen secondary outcomes/outcome measures include total falls, drug burden index (DBI), hospitalisations, mortality, activities of daily living (Barthel (proxy)) and quality of life (ED-5Q-5L (face-to-face & proxy)) and selected items from the STOPP/START guidance that could be assessed without need for clinical judgement. No adverse drug events were reported. The PIP service was generally well received by the majority of stakeholders (care home staff, GPS, residents, relatives and other health care professionals). PIPs reported feeling more confident implementing change following the training but reported challenges accommodating the new service within their existing workload. Conclusion Implementing a PIP service in care homes is feasible, and acceptable to care home residents, staff and clinicians. Findings have informed refinements to the service specification, PIP training, recruitment to the future RCT and the choice of outcomes and outcome measures. The full RCT with internal pilot started in February 2016 and results are expected to be available in mid late 2020.
eISSN: 2055-5784
Links: TBA
Embargo on file until: 1-Jan-10000
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2019, BMC (part of Springer Nature). Deposited with reference to the publisher’s open access archiving policy. (
Description: The file associated with this record is under embargo until publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.
Appears in Collections:Published Articles, Dept. of Medical and Social Care Education

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