Hospital Pharmacists' opinions on a risk prediction tool for
medication-related harm in older people
Abstract
Aim: Older adults are particularly affected by medication-related harm
(MRH) during transitions of care. There are no clinical tools predicting
those at highest risk of MRH post-hospital discharge. The PRIME study
(prospective study to develop a model to stratify the risk of MRH in
hospitalized patients) developed and internally validated a
risk-prediction tool (RPT) that provides a percentage score of MRH in
adults over 65 in the eight-weeks following hospital discharge. This
qualitative study aimed to explore the views of hospital pharmacists
around enablers and barriers to clinical implementation of the
PRIME-RPT. Methods: Ten hospital pharmacists: (band 6 (n=3); band 7
(n=2); band 8 (n=5)) participated in semi-structured interviews at the
Royal Sussex County Hospital (Brighton, UK). The pharmacists were
presented with five case-vignettes each with a calculated PRIME-RPT
score to help guide discussion. Case-vignettes were designed to be
representative of common clinical encounters. Data were thematically
analysed using a ‘framework’ approach. Results: Seven themes emerged in
relation to the PRIME-RPT: 1. providing a medicine-prioritisation aide;
2. acting as a deprescribing alert; 3. facilitating a holistic review of
patient’s medication management; 4. simplifying communication of MRH to
patients and the multidisciplinary team; 5. streamlining community
follow-up and integration of risk discussion into clinical practice; 6.
identifying barriers for the RPTs integration in clinical practice and
7. acknowledging its limitations. Conclusion: Hospital pharmacists found
the PRIME-RPT beneficial in identifying older patients at high-risk of
MRH following hospital discharge, facilitating prioritising
interventions to those at highest risk while still acknowledging its
limitations.