Reorganizing pharmaceutical care in family medicine groups for seniors with or at risk of major neurocognitive disorders: protocol for a mixed-methods study (Preprint)
Notice bibliographique
Résumé
BACKGROUND The latest global figures show that 55 million persons lived with major neurocognitive disorders (MNCDs) worldwide in 2021. In Quebec, Canada, most of these seniors are cared for by family physicians in interdisciplinary primary care clinics such as family medicine groups (FMG). When a person suffers from a MNCD, taking potentially inappropriate medications or polypharmacy (five different medications or more) increases their vulnerability to serious adverse events. With the recent arrival of pharmacists working in FMGs and their expanded scope of practice and autonomy, new possibilities for optimizing seniors' pharmacotherapy are opening. OBJECTIVE This project aims to evaluate the impact of involving these pharmacists in the care trajectory of older adults living with MNCD, in an interdisciplinary collaboration with the FMG team, as well as home care nurses and physicians. Pharmacists will provide medication reviews, interventions, and recommendations to improve the pharmacotherapy and education provided to these patients and their caregivers. METHODS This 2-step mixed methods study will include a quasi-experimental controlled trial (step 1) and semi-structured interviews (step 2). Seniors undergoing cognitive assessment, recently diagnosed with MNCD or receiving care for this at home, will be identified and recruited in FMGs in two Quebec regions. FMGs implementing the intervention will involve pharmacists in these patients’ care trajectory. Training and regular mentoring will be offered to these FMGs, especially to pharmacists. In control FMGs, no FMG pharmacist will be involved with these patients, and usual care will be provided. RESULTS Medication use (including appropriateness) and burden, satisfaction of care received, and quality of life will be assessed at study beginning and after six months of follow-up and compared between groups. At the end of the intervention study, we will conduct semi-structured interviews with FMG care team members (pharmacists, nurses, physicians) who have experienced the intervention. We will ask about the feasibility of integrating the intervention into practice, their satisfaction with and their perception of the intervention impacts for seniors and their families. We will assess the effect of improved pharmaceutical care for seniors with or at risk of MNCDs through the involvement of FMG pharmacists and a reorganization of pharmaceutical care. CONCLUSIONS The inclusion of pharmacists in interdisciplinary care teams is recent and rising, strengthened by more significant pharmacist practice roles. Results will inform the processes required to successfully involve pharmacists and implement developed tools and procedures transposable to other care settings to improve patient care. CLINICALTRIAL NCT04889794
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Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,058 | 0,042 |
| Méta-épidémiologie (sens strict) | 0,004 | 0,004 |
| Méta-épidémiologie (sens large) | 0,006 | 0,007 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,005 | 0,002 |
| Communication savante | 0,005 | 0,003 |
| Science ouverte | 0,005 | 0,003 |
| Intégrité de la recherche | 0,006 | 0,006 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,065 | 0,012 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».