An evaluation of an adapted United States model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland

Introduction: This study adapted and tested the implementation of a holistic United States (US) pharmaceutical care model in nursing homes in Northern Ireland (NI). Methods: A qualitative study involving healthcare professionals and resident advocates was conducted to inform the adaptation of the US model to suit the NI primary care environment. The adapted model was tested in a cluster randomised controlled trial (cRCT) conducted in nursing homes over 12 months. The primary outcomes were the change in the number of residents prescribed inappropriate psychoactive (anxiolytic, hypnotic or anti-psychotic) medicines and the number of falls. An economic evaluation was carried out to calculate the change in direct healthcare resource usage over time. Economic modelling, including multidimensional work sampling, was performed to estimate the costs of service provision. Results: From the qualitative study findings, the main adaptations required in the UK related to pharmacists' access to medical records, prescribers and nursing home residents. In the cRCT, 11 matched pairs of nursing homes and 334 residents participated. Overall 51% residents (n=171) were taking an inappropriate psychoactive mcdication (0.74/ rcsident). At baseline thcrc was no difference in the proportion taking inappropriate psychoactive medications in the intervention (92/173, 53%) and control groups (79/161, 49%). At 12 months there was a significant rcduetion (p