Better communication will improve medicines use
Appropriate use of medicines by elderly patients can be improved by targeting the abilities of individuals, with better doctor-patient and doctor-doctor relationships, and better systems for transferring information between care settings, according to a study published on BMJ
Online First last week.
Researchers interviewed doctors, nurses and pharmacists on five acute
care of the elderly wards in Belgium. In addition, they interviewed all
professionals and patients on two of the wards to gain an insight into
behaviours about which the interviewed health care professionals might
not be aware.
The researchers identified several factors that contributed to inappropriate
use of medicines. First, care was concentrated on short-term rather than
long-term treatment, there was limited transfer of information between
primary and secondary care and prescribing was not tailored to older
patients. Secondly, researchers found that doctors had a passive attitude
towards learning, relying on information gained from their superiors.
Finally, there was a paternalistic attitude to prescribing decisions
and difficulties in sharing decisions with other prescribers through
a reluctance to interfere with treatment delivered by colleagues and
fear of offending GPs.
The researchers also identified factors that lead to more appropriate
use of medicines, including multidisciplinary communication, a move from
a curative to a palliative approach and the input of a geriatrician.
“It might be interesting to study to what extent collaboration
with clinical pharmacists could help overcome some of the barriers described,” the
researchers suggest.
Derek Taylor, pharmacy manager at Broadgreen Hospital, Liverpool, and
chairman of the UK Clinical Pharmacy Association care of the elderly
group believes that a lot of the issues identified in this study are
relevant to the UK despite them having been highlighted as areas of concern
in the National Service Framework for Older People in 2001.
He told The Journal: “We still have a long way to go in this country
to tackle all of these problems.” However, he pointed out that
pharmacists specialising in the care of older people are making progress
by taking full drug histories on admission, setting up self-medication
schemes to help counsel and educate patients and identifying potential
issues with compliance and concordance.
Specialist discharge support teams, including pharmacists, help
to minimise the risk of the discharge process, as do pharmaceutical discharge
summaries
and referrals to primary care trust pharmacists for follow-up visits,” he
added. |
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