A Digitally-Enabled, Pharmacist service to detecT medicine harms in residential aged care (ADEPT): A feasibility study. (Preprint)

BACKGROUND Digital technologies have the potential to support proactive identification of early signs of medicine-related harms, including changes in sleep, physical activity, and cognition. The use of a centralised digital platform to support pharmacists in monitoring longitudinal health data and detecting medicine-related harms in this setting has not been evaluated. OBJECTIVE To develop and assess the feasibility of a digitally enabled pharmacist service to monitor signs and symptoms of medicine-related harms in residential aged care. METHODS The study was conducted in two phases. In Phase I, the establishment phase, health and medication data from participants’ records were exported into the TeleClinical Care (TCC-ADEPT) digital platform. Phase II comprised a 12-week feasibility study with assessments conducted at baseline, 4 weeks, 8 weeks, and 12 weeks. During this phase, the on-site residential aged care pharmacist monitored all participants using the centralised TCC-ADEPT platform. The digital technology intervention included collection of digital biomarkers to supplement information from patient care record and medication chart with subsequent display as longitudinal visualisations of change in residents’ health and medicine use using a cloud-based monitoring platform; TeleClinical Care. The aged care pharmacist monitored residents’ clinical, medicine, sleep, and physical activity data to identify signs and symptoms of medicine-related harms using the centralised platform and notified the residents’ general practitioners when necessary. The RE-AIM framework was used to evaluate the feasibility of the digitally informed pharmacist service. Assessments included service reach, changes in resident symptom scores as measured by the Edmonton Symptom Assessment Scale, medicine use, number of adverse events, cognitive scores as measured by the Montreal Cognitive Assessment, sleep and physical activity as measured by sleep sensor and accelerometer, number and types of pharmacist recommendations to general practitioners (GPs), and qualitative interviews. RESULTS Twenty-nine participants were enrolled in the study, with 27 completing the 12-week assessments. The average age was 86 years old, and 65% were female. There was a significant decrease in total numbers of adverse events at 12-weeks compared to baseline (45 at baseline, 27 at 12-weeks; p=0.006). There were no significant differences in changes in symptom scores, medicine use, cognitive scores, sleep, and physical activity. Overall, the pharmacist made 25 recommendations to the participants’ GP; with half (n=13, 52%) being implemented. Five residents, one family member, the on-site pharmacist, three staff members, and two members of senior management were interviewed to understand their views of the pharmacist service as well as facilitators and barriers to its delivery. Overall, participants reported positive views of the service, and senior management indicated an intention to continue using the service. CONCLUSIONS Our findings suggest that the digitally informed pharmacist service is feasible and has the potential to reduce adverse events due to medicines within the aged care setting. CLINICALTRIAL ACTRN12623000506695 INTERNATIONAL REGISTERED REPORT RR2-doi: 10.1136/bmjopen-2023-080148