Education and Assessment of Pharmacists on the Use of the Drug Burden Index in Older Adults Using a Continuing Professional Development Education Method

By Kouladjian, Lisa; Chen, Timothy F. et al. | American Journal of Pharmaceutical Education, May 2016 | Go to article overview

Education and Assessment of Pharmacists on the Use of the Drug Burden Index in Older Adults Using a Continuing Professional Development Education Method


Kouladjian, Lisa, Chen, Timothy F., Gnjidic, Danijela, Hilmer, Sarah N., American Journal of Pharmaceutical Education


INTRODUCTION

Aging is associated with an increase in multiple chronic diseases, polypharmacy and adverse drug events. (1,2) In particular inappropriate use of anticholinergic and sedative medications may contribute to poor clinical outcomes in older adults. (3) Pharmacists play an important role in medication management and clinical pharmacist interventions can reduce unplanned hospital admissions. (4) In Australia, consultant pharmacists can conduct home medicine reviews (HMRs), a government-funded community-based collaborative service provided by general practitioners and pharmacists. During an HMR, a patient's medications are reviewed to ensure their optimal use. (5) Recommendations provided by a pharmacist during the medication review are evidence-based and improve outcomes such as adherence and reduction in the number of falls among older adults. (6-8)

The Drug Burden Index (DBI) is a pharmacological risk assessment tool that measures a patient's total exposure to medications with anticholinergic and sedative properties. (9) A higher DBI is associated independently with hospitalization, frailty, falls, mortality, and impairments in function necessary for independent living in older adults. (10) The DBI is a valuable clinical tool in practice that optimizes health outcomes through reducing anticholinergic and sedative exposure in older adults. (11) Two retrospective analyses identified a significant reduction in DBI exposure for patients following recommendations provided by a consultant pharmacist's medication review. (12,13) However, evidence on recommendations regarding changes to sedative and anticholinergic medications and their impact on health outcomes in older adults is limited. (14,15) Therefore, training health care practitioners, especially pharmacists, is necessary to translate this tool into clinical practice.

In Australia, since the establishment of the Australian Health Practitioner Regulation Agency (AHPRA) in 2010, pharmacists in all Australian jurisdictions have a mandatory requirement to complete continuing professional development (CPD) to meet state and federal licenses to practice, comparable to continuing education (CE) in the United States. (16,17) The agency defines CPD as the means by which members of the profession continue to improve and broaden their knowledge, expertise, and competence, and develop personal and professional qualities throughout their professional lives. (18) In Australia, CPD is self-directed, practitioner-centered, and emphasizes practice-based learning, while CE is one component of the CPD model. (19) This makes CPD education an appropriate avenue for implementation and translation of research tools into practice. Most pharmacists prefer educational resources that are easily accessible at convenient times. (20) The improvement in pharmacists' professional practice is dependent on the form of CPD they undertake. For instance, CPD delivered as multi-interventional educational meetings can improve professional practice and health care outcomes for patients, but may not be effective for changing complex behaviors. (21) In contrast, printed educational material may have a small beneficial effect on professional practice outcomes, though little is known about its impact on patient outcomes or behavioral change. (22) Targeted educational interventions improve evidence-based practice skills and knowledge. (23)

An interventional study using CPD education to investigate pharmacists' knowledge and application of the DBI as a clinical risk assessment tool in older adults has not been conducted previously. The objectives of this study were to: (1) educate pharmacists and assess their knowledge of and ability to calculate the DBI to optimize medications for older adults, using a CPD education article; and (2) explore associations between pharmacist participant demographics and assessment performance.

METHODS

The intervention included a CPD education article published in Australian Pharmacist, the main professional journal of The Pharmaceutical Society of Australia (PSA). …

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