An exploration of community pharmacists'experience, knowledge and perspectives of frailty andmedicines optimisation in frail older people: Aqualitative study

ABSTRACT

Introduction: Frailty is a heightened state of vulnerabilitydue to an accumulation of age-related defects in separatephysiological systems (1). Frailty is becoming increasinglycommon, with up to 50% of older adults being diagnosedwith mild, moderate or severe frailty (35%, 12% and 3%respectively) (2). Community pharmacists may often bethe primary healthcare professional with whom frail olderpeople have most frequent contact due to their convenienceand accessibility. Therefore, it is hypothesised that community pharmacists could play a wider role in frailty identification and medicines optimisation for frail older people.Aim: To explore community pharmacists' knowledge of frailtyand its assessment, their experiences and contact with frail olderpatients in the community pharmacy setting, and their perceptions of their role in optimising medicines for frail older people.Methods:Two strategies were used to recruit community pharmacists registered in Northern Ireland (NI). Community pharmacists were recruited through the Pharmacy Forum NI bi-monthlynewsletter and the School of Pharmacy Undergraduate PlacementNetwork, followed by snowballing. The interview topic guidewas developed based on the published literature, current frailtyguidelines and through discussion within the research team;itwas piloted with four pharmacists. Semi-structured interviewscommenced in March 2020. Due to the Covid-19 pandemic,face-to-face interviews were logistically not possible, thereforetelephone interviews were conducted at a time convenient to participants. All interviews were recorded, transcribed verbatim andanalysed using inductive thematic analysis. Results: To date, 14 interviews have been conducted,lasting between 24 and 72 minutes. Apart from one interview, all were conducted over the telephone. Participant characteristics are summarised in Table 1. Analysis of interviewtranscripts is ongoing. Findings to date have highlighted thekey role community pharmacists feel they play in assistingfrail older patients with their medicines (especially duringthe current pandemic). Many saw themselves as a 'point ofcontact' for frail older people and highlighted the holistic approaches they used to care of such patients "It's easier to getin contact with us than other healthcare professionals and wetend to be the first port of call really" [CP2]. Interviews highlighted a lack of pharmacist knowledge surrounding frailtyas a condition and its assessment, with participants primarilyfocusing on the physical aspects of frailty (e.g. weight loss,weakness) when observing or 'informally assessing' patients.None of the participants reported formally assessing theirpatients using validated frailty tools or checklists "It's notsomething that I've ever thought about. We don't have anytools readily available to us that I know of and certainlynothing that would be standardised" [CP1].Conclusion: This study has highlighted that communitypharmacists felt they could contribute to optimising medicines for frail older people. However, the findings emphasisethe need for more formal training for community pharmacists about the clinical aspects of frailty, frailty assessmentand future interventions to address the medicines-relatedissues they have encountered with this patient population.