The utility of a computerised clinical decision support system intervention in home medicines review: A mixed-methods process evaluation

Mouna Sawan; Lisa Kouladjian O'Donnell; Emily Reeve; Danijela Gnjidic; Timothy F Chen; Patrick J Kelly; J Simon Bell; Sarah N Hilmer

doi:10.1016/j.sapharm.2020.06.010

The utility of a computerised clinical decision support system intervention in home medicines review: A mixed-methods process evaluation

Res Social Adm Pharm. 2021 Apr;17(4):715-722. doi: 10.1016/j.sapharm.2020.06.010. Epub 2020 Jun 10.

Authors

Mouna Sawan¹, Lisa Kouladjian O'Donnell², Emily Reeve³, Danijela Gnjidic⁴, Timothy F Chen⁵, Patrick J Kelly⁶, J Simon Bell⁷, Sarah N Hilmer²

Affiliations

¹ NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; School of Pharmacy School, Faculty of Medicine and Health, Sydney University, New South Wales, Australia; Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, New South Wales, Australia. Electronic address: mouna.sawan@sydney.edu.au.
² NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, New South Wales, Australia.
³ NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, South Australia, Australia; Geriatric Medicine Research, Faculty of Medicine, College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada.
⁴ School of Pharmacy School, Faculty of Medicine and Health, Sydney University, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Australia.
⁵ School of Pharmacy School, Faculty of Medicine and Health, Sydney University, New South Wales, Australia.
⁶ School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia.
⁷ NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.

PMID: 32788083
DOI: 10.1016/j.sapharm.2020.06.010

Abstract

Background: Use of high-risk medications is common and associated with adverse effects in older adults, including those living with dementia. A Computerised Clinical Decision Support System (CCDSS) called G-MEDSS© (Goal-directed Medication Review Electronic Decision Support System) contains tools that identify medications with anticholinergic and sedative effects and align older adult's health and medication goals of care with medication management strategies.

Objectives: To describe the utility of a CCDSS called G-MEDSS in Home Medicines Review (HMR) by an accredited clinical pharmacist (ACP) using a mixed-methods process evaluation method.

Methods: A mixed-methods process evaluation was conducted as part of a nation-wide cluster-randomised clinical trial evaluating the effectiveness of implementing G-MEDSS in HMR. Data were collected from ACPs and HMR recipients (the patient) using a feedback survey (ACPs and HMR recipients) and one-on-one telephone interviews (HMR recipients). Quantitative and qualitative data were combined at the start of analysis. Content analysis of the qualitative data was conducted, and emerging categories were linked to quantitative data.

Results: Feedback surveys were completed by eight ACPs and 26 HMR recipients; 11 HMR recipients completed one-on-one telephone interviews. Overall, ACPs and HMR recipients who received the intervention reported a positive attitude towards the utility of G-MEDSS in HMR. ACPs reported that G-MEDSS enhanced their ability to make evidence-based recommendations about anticholinergic and sedative medications, and to better align HMR recommendations with HMR recipients' goals of care. However, ACPs described that it was difficult to obtain goals of care from HMR recipients. HMR recipients gave mixed reports about the ACPs consultations: some HMR recipients reported that they were engaged in discussions about their views on medications, whilst other participants reported that discussions about their concerns towards medications and goals was limited.

Conclusions: This study suggests that a CCDSS, such as G-MEDSS, demonstrates good utility to assist ACPs to identify and assess anticholinergic and sedative medications. Given the mixed feedback from the ACPs on the different components of the G-MEDSS, further refinement of these tools and their use in combination in practice may be needed.

Keywords: Dementia; Deprescribing; Drug burden index; Evaluation; Home medicines review; Mixed-methods; Older adults; Patient centred care.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cholinergic Antagonists
Decision Support Systems, Clinical*
Humans
Pharmacists
Referral and Consultation

Substances

Cholinergic Antagonists