Validation of a framework to support the design and evaluation of pharmacy-led medicines optimisation in care homes: a mixed methods online survey

Problem

Nearly half a million people are living in care homes in the UK, around 70% of which have dementia and high levels of multimorbidity. Older people are the major users of medication. In the last 20 years, there has been a dramatic increase in the prevalence of polypharmacy with the number of older people taking five or more medicines increasing from 12% to nearly 50%. Therefore, an initiative was undertaken to develop a framework to support pharmacist-led medicines optimisation within care homes. The framework was locally validated by a range of health care professionals (see Hilton et al., 2020, p.12-13: https://sapc.ac.uk/sites/default/files/asm_20_abstract_book2.pdf). Reviewers were asked to rate elements of the draft framework for inclusion, and suggest any changes that should be added to the next draft framework. The framework was revised based on this feedback and used to inform the current study.The aim of this research is to validate the existing framework nationally across the UK. There were three objectives:1. Develop, pilot and launch an online survey2. Analyse the survey data3. Revise and validate the framework based from the survey data

Approach

Health and social care professionals working in UK care homes were invited to participate in an online survey, which included a range of closed and open-ended questions based on the contents of the framework. A mixed-methods, results-based, convergent synthesis design was adopted, where quantitative and qualitative data were collected simultaneously and integrated in the analysis. Convenience sampling, using a cascading, snowballing method, was used; data was collected between 5th November 2020 and 16th March 2021. Content Validity Index (CVI) was used to ascertain the validity of the framework. Theoretical thematic analysis was used to analyse participants’ comments on the framework.

Findings

100 health and social care home professionals completed the survey. Overall the framework scored highly on the Scale-Content Validity Index/Average (S-CVI = 0.87). Qualitative data revealed areas of strong agreement, as well as areas of improvement of the framework, including; 1. Who to involve prior to a medicine’s optimisation review; 2. Having a range of training methods; 3. The process of what to include when completing a review and 4. Who should receive and review recommendations made by the review. The feedback was used to revise and improve the framework.

Consequences

This validated and revised framework could be used as a way to standardise practice and improve medicines optimisation in care homes. Further work is needed to embed the framework within practice and evaluate the use clinically to improve medicines optimisation.