NHS Doncaster Community Pharmacy Falls Prevention Service Evaluation
May 2014
Background
Falls & fall-related injuries are a common & serious problem nationally costing an estimated £2.3 billion annually.1
In Doncaster between April 2013 and February 2014 there were 2409 emergency admissions due to all injuries caused by falls at a cost of £6,463,415.2
Falls and falls-related injuries have an impact on quality of life, health and healthcare costs.People aged 65 years and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year.1 Consequences of falling include; fractures, head injuries, psychological problems i.e. social isolation/depression, disability, loss of independence, need for long term residential/nursing home care or even death.Falling also affects family members and carers of people who fall.1
Rationale for the new service
Many of the risk factors for falls are potentially modifiable and there is growing evidence of cost effective interventions to prevent falls.3People aged over 65 visit pharmacies on a regular basis.Community pharmacies are easily accessible, open at convenient times and have private consultation areas.With their knowledge of medicines and bone heath community pharmacists could be effectively utilised to provide falls and fracture prevention services.4
Doncaster Local Pharmaceutical Committee (LPC) developed a Community Pharmacy Falls Prevention Service commissioned by NHS Doncaster using Winter Funding. This report provides a summary of the findings from evaluation of this new service.
Aims of the service
To address primary prevention of falls and fractures: identifying patients at risk and preventing the first fall/fracture. To identify patients who have fallen in the last 12 months.
Community Pharmacy Falls Prevention Service
Patients aged 65 years and over taking 3 or more medicines or ‘high-risk’ medication are targeted for a consultation with a pharmacist who has undertaken falls prevention training. The pharmacist takes a falls history, identifies any ‘high-risk’ medicines,potentially fall-inducing side effects, performs an assessment of gait/balance and enquires about problems with vision/continence. Patients are provided with oral falls and fracture prevention advice and a leaflet.
Patients who have fallen in the past year are referred directly to the Specialist Falls Clinic.
Service Evaluation
Aim and Objectives: To evaluate a community pharmacy falls prevention service. To identify the number of patients using the service, risk factors being identified and interventions provided by community pharmacists, exploring patient satisfaction with the service and ideas for service development.
Setting: Twenty-three community pharmacies across Doncaster.
Methods: A mixture of research methods were used for data collection: audit of 414 consultations, analysis of 353 patient satisfaction questionnaires and a face-to-face meeting with a Falls Co-ordinator. Audit and questionnaire results were analysed using descriptive statistics, qualitative comments using a thematic approach.
Limitations:Information and investigator bias, and poor piloting and design of the data collection tools limited the methods used.
Evaluation Results
Overall Scheme Cost and Period Covered
Total cost of the service from January-March 2014 including initial set-up/training costs and evaluation: £6730.
A&E Attendances and Admissions Avoided
The short time period the service has been running for and the multifactorial nature of falls make it difficult to identify whether or not the service has had an impact on A&E attendances/admissions.
Falls Risk Factors Identified
The most frequently identified risk factor for falling was ‘high-risk’ medication.
Risk Factors and Falls in the Last Year:
Statistically significant relationships were found between fall-inducing side effects or balance/gait problems and falling (p<0.001), with 31% of patients experiencing potentially fall-inducing side effects and 42.9% with balance/gait problems having fallen in the last year.
Bone Health
Over 50% of patients who had suffered a previous fragility fracture were not prescribed bone-sparing medication. Thirty-seven percent of patients’ prescribed bone-sparing medication reported compliance problems.
Outcomes Following the Consultations
The majority of consultations resulted in primary prevention interventions provided by the pharmacist indicating a low impact on GP and falls clinic workload.
A previous fall is the most significant risk factor for falling. The 10% of patients referred to the falls clinic by the community pharmacists are unlikely to have been referred/had access to falls prevention interventions and advice if this new service had not existed.
Patient Questionnaire Results
Patient feedback was extremely positive.
“Support was amazing after poor service from DRI A&E. The pharmacy has done more to support my falls and reduce readmission to A&E which is for me a step in the right direction”Patient.
Feedback from Falls Co-ordinator
Feedback was positive: “the service is beneficial, it is accessing a group of patients that might not be accessing other services”.
Recommendations for development/improvement
This service should be continued and developed further to work more closely with other health professionals, include service provision for housebound patients and help reduce the number of medicines being taken by older people. An osteoporosis screening service should be developed to complement this service to help reduce fracture rates.
An electronic consultation record should be developed to reduce the paperwork burden of the service. The type of data collected should be reviewed and the tool thoroughly piloted to improve data collection for future evaluation. The service should be promoted.
Conclusion
This evaluation has demonstrated there is a much needed role for community pharmacists in primary falls prevention; they can successfully identify patients at risk, provide patient education and make appropriate referrals to the specialist falls clinic. Funding for this new and unique service should continue as it addresses primary prevention of falls, which are a common problem with serious consequences. Patient satisfaction with the service is high, it is supported by the specialist falls service and it is accessing patients who are not accessing other services.
References
1.National Institute for Health and Care ExcellenceClinical Guideline 161. NICE 2013. 2. NHS Doncaster CCG3. Moylan K.C, Binder E.F. The American Journal of Medicine 2007;120:493-497 4.Law A.V, Shapiro K. Journal of Evaluation in Clinical Practice 2004;11(3):247-255.For further information contact:
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