Assessment of a United States pharmaceutical care model for nursing homes in the United Kingdom
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To assess the suitability of an American model of pharmaceutical care for nursing home residents (The Fleetwood model) for application in nursing homes in the United Kingdom.
Pharmacists (those from a hospital setting or involved in prescribing support), general practitioners, nursing home managers and advocates for older people were invited to participate in semi-structured interviews or focus groups. The American Fleetwood model was explained to all participants who were asked for their views and opinions on how such a model could be adapted for use in the UK setting. All interviews and focus groups were tape-recorded, transcribed verbatim and analysed using the framework method.
Main outcome measure
An adapted model of pharmaceutical care for use in UK nursing homes.
There was general concern about prescribing in nursing homes, particularly in relation to psychoactive drugs. All participants were supportive of the proposed model of care and endorsed the greater involvement of pharmacists. However, participants also recognised that unlike pharmacists in the US nursing home setting for which the Fleetwood model had been developed, pharmacists implementing this approach in the UK would face major challenges in relation to access to records (medical and medication), prescribers and residents.
The findings highlighted the key elements of access which will need to be considered if this model of pharmaceutical care is to be applied to nursing home residents in the UK.
Impact of findings on practice
The model has been revised to take account of the challenges relating to access and will be tested in a randomised controlled trial.
KeywordsNursing homes Prescribing Pharmaceutical care Qualitative research United Kingdom
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The authors wish to thank all of the participants who volunteered for this study. Susan Patterson is currently being supported by a Doctoral Fellowship from the Research and Development Office, Northern Ireland; Carmel Hughes is currently being supported by a Cochrane Fellowship from the Research and Development Office, Northern Ireland. The American Fleetwood project was supported in part by a grant from the Commonwealth Fund and a grant from the Retirement Research Foundation
Potential conflict of interest: none
- 3.Institute of Medicine. Improving the quality of care in nursing homes. Washington, DC; National Academy Press. 1986; ISBN: 0309078873Google Scholar
- 13.Office of Inspector General. Prescription drug use in nursing homes. Report no. OEI-069600081; 1997Google Scholar
- 14.Cameron K, Feinberg JL, Lapane KL. Fleetwood project Phase III moves forward. Consultant Pharmacist 2002;17:181–98Google Scholar
- 23.Medical Research Council. A framework for development and evaluation of RCTs for complex interventions to improve health. London; Medical Research Council. 2000Google Scholar
- 24.Hughes CM. Long-term care of the elderly: challenges in pharmaceutical care. J Soc Admin Pharm 2000;17:66–70Google Scholar
- 26.Spong L. Role of the pharmacist in nursing homes in northern Europe. Pharm J 1992;249:23–5Google Scholar
- 30.Hughes CM, Turner K, Fitzpatrick C, Linton A, Laird T. The use of a prescribing audit tool to assess the impact of a practice pharmacist in general practice. Pharm J 1999;262:27–30Google Scholar