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GERIATRICS

Pharmacotherapy Interventions Undertaken by Pharmacists in the Fleetwood Phase III Study: the Role of Process Control

Associate Professor of Medical Science, Department of Community Health, Brown University, Providence, RI

Carmel M Hughes, PhD

Professor of Primary Care Pharmacy, School of Pharmacy, The Queen's University of Belfast, Belfast, Northern Ireland

Reprints: Dr. Lapane, Department of Community Health, Brown Medical School, Box G-H 105, 167 Angell St., Providence, RI 02912-9107, fax 401/863-7913, Kate_Lapane{at}Brown.edu

BACKGROUND: The Fleetwood Model incorporates prospective review, direct communication with the prescriber, and formalized pharmacotherapy planning in patients at highest risk for medication-related problems.

OBJECTIVES: To describe the intervention activities performed by consultant pharmacists and dispensing pharmacists in the context of the Fleetwood Phase III Study.

METHODS: We report on a total of 4272 residents living in 12 nursing homes included in the intervention arm of the demonstration project. The intervention period was January through December 2004. Using pharmacotherapy planning software with a Webbased interface, daily interchange of information from the commercial pharmacy software, as well as laptop-based software for use in the nursing homes, pharmacists documented the reason for the intervention, the level of service, and the extent to which the recommendations were accepted.

RESULTS: There were 2118 Fleetwood interventions performed on 4272 residents (intervention rate: 9.48/100 resident months), with 81% of interventions performed by consultant pharmacists. The top 5 reasons for Fleetwood interventions by dispensing pharmacists were: missing information/clarification needed (19.8%), drug-age precautions (14.4%), excessive duration alert (9.5%), suboptimal regimen (8.7%), and laboratory test needed (7.3%). The top 5 reasons for involvement of the consultant pharmacists were: laboratory test needed (13.1%), missing information/clarification needed (13%), unnecessary drug (10.3%), product selection opportunity (10.3%), and excessive duration alert (9.1%).

CONCLUSIONS: Extending the federally mandated medication review process in nursing homes to incorporate elements of the Fleetwood Model is possible. The recommendation acceptance rates for pharmacist interventions are high.

Key Words: Fleetwood Model, geriatrics, nursing home, pharmacy practice

Published Online, August 1, 2006. www.theannals.com, DOI 10.1345/aph.1G702

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