Reorganizing pharmaceutical care in family medicine groups for seniors with or at risk of major neurocognitive disorders: protocol for a mixed-methods study (Preprint)
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.058 | 0.042 |
| Meta-epidemiology (narrow) | 0.004 | 0.004 |
| Meta-epidemiology (broad) | 0.006 | 0.007 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.005 | 0.003 |
| Research integrity | 0.006 | 0.006 |
| Insufficient payload (model declined to judge) | 0.065 | 0.012 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".