Preventing Falls Among Older Adults: The Role of the Community

Pharmacist

David A. Mott, PhDBarb Michaels, RNJeff Kirchner, RPh

Funding & Team

• ICTR Pilot Grant– 1UL1RR025011 (Mott) 07/01/11–06/30/12 CTSA program

of NCRR/NIH

• Team– Brown County ADRC– Streu’s Pharmacy, Green Bay– University of Wisconsin- Madison School of Pharmacy

• Sonderegger Research Center– University of Wisconsin-Madison School of Medicine– Community Academic Aging Research Network (CAARN)

Motivation for the Study

• Falls and Drugs– Fall risk-increasing drugs (FRIDs)– Common use of FRIDs

• Stepping On– Medication management workshop

Study Goals• Focus on improving management of medications

by Stepping On participants.

• The purpose of the study is to test the feasibility of two different methods to modify medication use by Stepping On participants.

• The main hypothesis to be tested is whether an individualized, pharmacist-provided MTM session is feasible and will result in more medication modification compared to not providing the pharmacist-led MTM.

• Identify barriers and facilitators.

Study Specifics

• Study Groups- Random assignment (SO class level) to one of two groups.

- Group A (n =40) receives a pamphlet describing strategies to change medication use.- Group B (n = 40) receives the pamphlet as well as meets with a pharmacist to review their medication.

• Subjects are followed for six months• Subjects are paid $50.

Study Specifics• All study subjects participate in:

– A 60 minute pre- and post-intervention telephone interview to collect health, medication use, and falls history information.

– A 30 minute follow-up telephone call every 30 days (a total of five follow-up telephone calls) after the intervention to collect information about medication use and any falls events. Tools provided to subjects to aid recall.

– All phone call interviews occur between a student pharmacist and a study subject. Attention is focused on building a relationship, appointment setting, and quality of conversation and data collection.

– All conversations with students are audio-recorded.

Study Specifics

• Treatment Group– Meet with a pharmacist for 1 hour at a pharmacy

located in downtown Green Bay to review their medications. Pharmacist uses patient data collected in interviews and clinical algorithm for FRIDs developed by study personnel and pharmacist.

– Pharmacist discusses medication modifications with patient and communicates with prescriber. Pharmacist tracks all modifications.

– A telephone follow-up session with the pharmacist occurs about 3 months after the first session.

– All conversations with pharmacist are audio-recorded.

Recruitment

• Last class session of 7-week Stepping On workshop.

• Study is discussed as first topic of session.• Discussion led by IRB-trained study personnel.• Subjects can consent at the session or

afterwards following phone call.• Role of ADRC

Recruitment

• Results– Recruitment rate to date– Recruitment patterns– Reasons for “yes” and “no”

MTM Session with Pharmacist

• Initial patient response• Pharmacist recommendations• Physician follow-up• Patient follow-up

Preliminary Results

• Study Enrollment• FRID Use• MTM Impact

– Physician response

Questions