Community pharmacists can help reduce use of antipsychotic medication in people with dementia, study stays

Specially trained pharmacists can play a positive role in better managing the appropriate use of antipsychotic medicines for people with dementia in care homes, according to an audit of a pilot.

In the pilot, where specially trained pharmacists were used, 26% of residents reviewed did not have any symptoms which necessitated regular antipsychotic medication, and in almost two thirds (58%) of cases the risk of the medication was deemed to outweigh the benefit of it. 

In addition, the audit resulted in more than 20% of residents having their antipsychotic dose reduced, and more than 17% realising antipsychotic medication discontinuation. 

The audit was undertaken by selected Boots UK pharmacists, some of whom had received additional Alzheimer’s Society training to enable them to better support people with dementia and carers. The results are published in Nursing Times.

Alistair Burns, national clinical director for dementia at NHS England said: “The prescribing of antipsychotic drugs in people with dementia is associated with increased mortality and morbidity. This exciting publication underscores the key role that pharmacists have in optimising prescription of medication in this potentially vulnerable population.”

The study was commissioned by Boots UK in order to demonstrate the potential added value that community pharmacy can offer, and the contribution this service could make to the NHS. The pilot demonstrated how commissioning pharmacy services could help improve the care of vulnerable patients who live in residential care homes, working in partnership with other healthcare professionals. 

It evaluated the use of antipsychotic medicines across 463 care homes over a 2-year period. Also, community pharmacists, including those specially trained, worked alongside the healthcare professionals responsible for people with dementia within care homes to create an action plan for the use of antipsychotic medication in line with National Institute for Health and Care Excellence guidance.

Dr James Pickett, head of research at Alzheimer’s Society, said: “Alzheimer’s Society has long campaigned for alternatives to antipsychotic medications as they are potentially harmful and can worsen the symptoms of dementia. This audit highlights the important role that community pharmacists can play in making sure these alternatives are considered. We’ve seen a 50% reduction in the prescription of anti-psychotics to people with dementia in recent years and, in light of this new evidence, we hope this trend will continue.”

David Wright, professor of pharmacy practice at the University of East Anglia and one of the study authors added: “Reducing the use of antipsychotic drugs for people with dementia is a government priority, and this audit has shown that collaborative working between pharmacists, GPs, nurses and care home staff is a key way of addressing this objective. Pharmacy is an underused resource within the NHS and this latest research demonstrates a valuable role community pharmacists can play in improving patient care.”

Asif Aziz, director of care services, Boots UK, added: “Better medicines optimisation has been identified as a key way to supporting patients more effectively and we know that it can make a real difference to patient’s lives – especially those living with long term conditions. This pilot demonstrates how, if commissioned at a national or local level, pharmacy could play a crucial role in supporting patients to get the most from their medicines.”