Carmel Hughes : Optimising prescribing of medicines in older people- approaches and outcomes скачать в хорошем качестве

Carmel Hughes : Optimising prescribing of medicines in older people- approaches and outcomes

Samedi 18 octobre 2025 - Séance publique ordinaire Carmel HUGHES, Professor of Primary Care Pharmacy, School of Pharmacy, Queen’s University Belfast, Northern Ireland Prescribing medications is the most common healthcare intervention experienced by older people. This presentation will highlight research which has focused on prescribing for older people in nursing homes, an environment in which there have been a number of concerns about the quality of care. Epidemiological work has shown that having a strong regulatory framework at a national level may influence prescribing of some medications, notably psychoactive medications and evidence suggests that a regulatory approach appears to work best in preventing poor quality care rather than promoting good care. Therefore, rather than a complete reliance on regulation, collaboration between physicians and pharmacists has been suggested as an alternative strategy, particularly in reducing the prescribing of medicines which are known to lead to adverse effects in older nursing home residents. Two randomized controlled trials have demonstrated the impact of pharmacists, working in collaboration with physicians, in improving prescribing. One trial, which focused on pharmacist assessment of medication appropriateness and feedback to physicians, showed a marked decrease in the prescribing of inappropriate psychoactive medication following this pharmacist intervention compared to usual care. A second trial, in which suitably trained and qualified pharmacists assumed responsibility for prescribing all medicines for nursing home residents, showed a reduction in the Drug Burden Index, compared to usual care. However, what is less clear is the impact of changes in prescribing on other outcomes such as health-related quality of life and cost-effectiveness. Therefore, consideration should be given to what outcomes we should measure in studies from the perspectives of all key stakeholders, particularly patients. There is growing interest in the development of core outcome sets (COSs) which represent a defined group of outcomes that should be used in all trials which are focusing on similar topics. COSs should be developed with input from a range of stakeholders including patients and members of the public, and a COS for nursing home studies will be discussed.