(99) Implementation of a Living Lab Intervention in Family Medicine Groups to Improve Medication Use for Seniors with Neurocognitive Disorders

Publication Number: 430

Background: In 2019, over 57 million seniors had major neurocognitive disorders (NCD) worldwide. These seniors may be exposed to polypharmacy and inappropriate medications, increasing their vulnerability to autonomy loss. In Quebec, Canada, many Family Medicine groups (FMG) include pharmacists in multidisciplinary primary care teams who perform medication reviews, adjustments, follow-ups and provide suggestions for medication optimization. Despite provincial recommendations, not all FMG involve pharmacists in the clinical assessment of seniors with NCD.

Objectives: To evaluate the impact of pharmacists’ involvement on medication use and well-being of seniors with NCD.

Methods: This pragmatic, controlled study evaluates a living lab-type intervention in two regions of Quebec. Seniors under cognitive assessment, recently diagnosed with major NCD or receiving care for this at home are currently being recruited in FMGs. FMGs implementing the intervention involve pharmacists in these patients’ care trajectory, training and regular mentoring are offered. Interdisciplinary collaboration among pharmacists, physicians and nurses for medication optimization of eligible seniors is fostered. In control FMG, no on-site pharmacist is involved, and usual care is provided. Medication use and burden, satisfaction, and quality of life are assessed at study beginning and after six months. Health care use and the FMG teams’ experiences with the intervention are also assessed.

Results: Despite COVID-19 related challenges, training and patient recruitment tools were developed and tested with clinicians and patient collaborators. The intervention is currently being implemented in seven FMG and planned for another. To date, 76 patients have been approached, 60 agreed to participate and completed the first questionnaires. 61.4% were women. Mean age was 81 years. Mean drugs per patient was 9.3. Mean MMSE score was 24.1/30. The living lab’s flexibility and malleability allowed to iteratively adapt the implementation process and data collection methods, to accommodate the FMGs teams’ and patients’ needs. This research will add new knowledge on the impact of pharmacists’ involvement in FMGs and home care for seniors with NCD to address the "epidemic of polypharmacy in geriatrics”.

Conclusions: The living lab concept and the clinicians’ motivation to optimize medication use for these seniors enabled the project’s deployment despite pandemic-related challenges faced by FMGs and patients. Results will inform the processes required to successfully involve pharmacists and implement developed tools and procedures transposable to other care settings to improve patient care.