Pharmacist-led medication reviews for older care home residents: achieving a person-centred approach

Background: Clinical pharmacists in England are responsible for undertaking Structured Medication Reviews (SMRs). Guidance state these should be person-centred and holistic, however there is no universally accepted definition or model of person-centred care.

Aim: To identify how pharmacist-led SMRs for older people in care homes can become more person-centred.

Methods: Qualitative approach using semi-structured virtual interviews, conducted across three stakeholder groups: care home pharmacists (n=18), care home staff (n=8), and family representatives of older care home residents (n=11). Data were analysed using reflexive thematic analysis.

Findings: Findings are presented under three overarching themes: what does it mean to be person-centred?; systems of work and the ‘messy reality’ of the care home pharmacist’s role; and factors influencing the ability of the pharmacist to undertake a SMR in a person-centred way. Pharmacists, care staff, and family representatives shared similar understandings of the approaches needed in order for pharmacist-led SMRs for older care home residents to be person-centred, as well as the features of a person-centred review. In addition, person-centred reviews were seen as being informed by key knowledge sources: pharmacist knowledge; resident and family knowledge; care staff knowledge; and general practitioner and wider multidisciplinary team knowledge. The ability of the pharmacist to undertake reviews in a person-centred way was influenced by the systems of work and shaped by additional contextual factors.

Conclusion: Despite an acknowledgement by study participants of the benefits of a person-centred approach, this was not always achievable. A contextualised model of pharmacist-led SMR in care homes was developed based on study findings. This will support pharmacists undertaking SMRs for older care home residents, within the confines of limited time, to self-assess if their SMRs are person-centred, and consider “am I doing this?”