(286) Description of interventions performed by pharmacists involved in the care of older adults with neurocognitive disorders in family medicine groups in Quebec, Canada

Background: In the province of Quebec, Canada, pharmacists have been integrated into Family Medicine Groups’ (FMG) interprofessional primary care teams, since 2015. In recent years, regulatory changes have expanded their autonomy for managing pharmacotherapies in targeted populations and under defined conditions. Little is known about the precise nature of pharmacists’ interventions and their impacts in these primary care settings.

Objectives: The objective of this study was to describe the interventions performed by FMG pharmacists regarding older adults in investigation for or recently diagnosed with neurocognitive disorders.

Methods: Within a larger quasi-experimental study on the effects of FMG pharmacists’ involvement in the trajectory of these patients, we performed a cross-sectional descriptive analysis of pharmacists’ interventions, including those directly implemented and those recommended to prescribers.
We collected information on interventions through structured online interviews with pharmacists between August and October 2023 on interventions performed between January 1st and June 30, 2023. This time window allowed us to mitigate recall bias at the time of data collection.
All interventions were discussed with the pharmacists and classified according to the Drug-Related Problems classification of the Pharmaceutical Care Network Europe, V9.1. We performed a descriptive analysis to report frequencies of performed interventions, detected drug-related problems and associated causes of these problems.

Results: We collected data on 144 interventions performed by five pharmacists involving 32 patients (median number of interventions per patient = 3.5; [interquartile range: 2.5 – 6.5]). Of these interventions, 37.5% (n=54) were implemented by the pharmacists themselves, primarily dosage adjustments, starting of new drugs and patients counselling, while the rest were recommendations to prescribers. The most common drug-related problem was treatment effectiveness problems (58%, n=84). The two leading related causes were incorrect drug selection (52%, n=44) and incorrect dose selection (32%, n=27). Pharmacists’ interventions were accepted 68% of the time (n=61). Detected drug-related problems were considered either fully or partially solved 69% of the time (n=100).

Conclusions: Despite having increased autonomy for interventions, pharmacists in this study predominantly made recommendations to prescribers who typically embraced them, and frequently requested the pharmacist to implement these interventions. The FMG pharmacists prioritized collaboration, opting to propose recommendations before acting independently.