Living with dementia in care homes: the nature, role, and impact of pharmaceutical care provision by community pharmacists

Background Dementia poses a great challenge for health care systems worldwide, with the population of affected people over the age of 60 estimated to reach 152 million by the year 2050. Dementia is acknowledged as being one of the strongest determinants of entry into residential care in people aged over 65 and it is estimated that nearly 70% of residents have dementia. Medication remains the most frequently used intervention for dementia patients, and pharmacists are arguably the nation’s experts on medication. In Great Britain, they are easily accessible and provide services to care homes as an enhanced service in the pharmacy contract. This research sought to establish the role and impact of community pharmacists on the pharmaceutical care of people living with dementia in care homes. Methods The research was conducted in four stages employing qualitative and quantitative methodology. A qualitative study was conducted with community pharmacists who provided services to care homes for residents living with dementia in Essex and in Kent. This was followed by a quantitative survey of a wider population of community pharmacists across England. Qualitative interviews with care home staff explored their views about pharmacy services provided to residents with dementia. Finally, a dementia intervention tool to support pharmaceutical care through comprehensive medication reviews was developed and tested among a focus group of pharmacists. Results My research revealed that pharmacists mainly provided medication supply services to residents with dementia. Barriers to optimal pharmaceutical care included time, knowledge, communication, and access to patient records. Care staff revealed a desire for timely supply of medication, and help dealing with residents’ challenging behavior including refusal to take medications. Better communication between MDTs and training of care home staff would improve patient care. The dementia medication review intervention toolkit was deemed useful by the focus group of pharmacists following preliminary testing. Conclusion Participating pharmacists considered their service provision as meeting contractual obligations despite structural barriers. A tool to facilitate effective medication review was deemed useful as an aide-memoire. Further feasibility research to support wider adoption is needed.