Improving Medication Therapy Through a Digital Interdisciplinary Medicine Therapy Optimisation Model

Improving Medication Therapy and Patient Involvement Through a Digital Interdisciplinary Model Among Old People in Primary Care Living in Sparsely Populated Regions in Sweden

In this study, a telepharmacy service in primary care for home-living older adults in Northern Sweden's rural areas will be developed and evaluated. The primary objective is to evaluate the effect of the service regarding the identification, classification, and resolution of medication-related problems (MRPs). Secondary objectives are to evaluate participants' medication adherence, health-related quality of life, and beliefs about medicines through self-report questionnaires. The telepharmacy service include medication interviews, structured medication reviews, interdisciplinary patient-centred discussions, and follow-ups.

Participants that meet the inclusion criteria will be invited to participate in the study via mail. The participants will also receive three validated questionnaires; Medication Adherence Report Scale-5 (MARS-5), EuroQol-5 Dimension-5 Level questionnaire (EQ-5D-5L) and The Beliefs about Medicines Questionnaire (BMQ) to fill in prior to initiation of the study, to collect baseline data. The intervention consists of several steps, and all meetings will be conducted through video conferencing via a secure virtual care platform. Initially, the participant will have a medication interview with a clinical pharmacist, Next, the clinical pharmacist conducts a structured medication review based on information from the interview and the participant's medical records and laboratory values. The clinical pharmacist and the participant's primary care physician will then have a video-based interdisciplinary meeting. During this meeting, the clinical pharmacist presents recommendations to resolve potential MRPs, and the physician may accept or reject the pharmacist's recommendations. The primary-care physician informs the participant about any changes in their medication therapy and follows-up and monitors these changes. Video-based follow-up meetings between the participant and the clinical pharmacist will take place 1-2, 4 and 12 weeks after the first video-based meeting. Additional meetings can be scheduled, if requested by the participant, or if considered necessary by the clinical pharmacist. The clinical pharmacist will also conduct medical record reviews once every two weeks during the 12-week intervention period. At 12 weeks, after the last follow-up, the participant will be asked to fill in the three questionnaires one more time.

Inclusion Criteria:

• Using five or more prescribed medications and/or considered as a potential candidate by the primary care physician.
• Living at home (i.e not in a nursing home)
• Registered at primary healthcare centres in rural municipalities within Västerbotten County (and neighbouring counties if necessary)

Exclusion Criteria:

• Do not speak Swedish
• Unable to communicate
• Has a confirmed major neurocognitive disorder
• Receives palliative care