Title: Improving Over-the-Counter Medication Safety for Older Adults
Project Overview
This study examines effectiveness of an innovative pharmacy design change on over-the-counter (OTC) medication misuse in adults older than 65. A structural pharmacy redesign (the Senior SectionTM) was conceptualized to increase awareness of higher-risk OTC medications. The Senior Section contains a curated selection of OTC medications and is close to the prescription department to facilitate pharmacy staff/patient engagement to reduce misuse.
Background:
Adverse drug events (ADEs) associated with over-the-counter (OTC) medications cause 178,000 hospitalizations each year, representing a major patient safety concern. Older adults aged 65+, one of AHRQ’s priority populations, are particularly vulnerable to ADEs. Of the 2.2 million older adults who are at risk for a major ADE, more than 50% of them are because of concurrent use of an OTC and prescription medication.
Community retail pharmacies, where most older adults purchase OTC medications, are unique health care settings characterized by extended hours and access to a pharmacist who can provide free medication guidance. Unfortunately, the design of most community pharmacies is poor and contributes to misuse of high-risk OTCs.
Aims
Aim 1. To refine the system redesign intervention and implementation strategy through diagnostic and formative evaluation.
Aim 2. To evaluate the effectiveness of a refined system redesign intervention on preventing misuse of high-risk OTC medications by older adults.
Aim 3. To evaluate the implementation of a refined system redesign intervention in community pharmacies.
Scope
This study took place in four Shopko Stores in Wisconsin. Shopko Stores was a chain of mass merchandise stores with multi-department operations. The company operated over 300 stores located in 20 states, typically in small to mid-sized communities. Most Shopko Stores had a pharmacist available the majority of time that the store was open, and stocked several large aisles of OTC products. Unfortunately, during post-intervention data collection, Shopko stores filed for bankruptcy and closed all sites.
Conceptual Framework
The conceptual framework for this intervention is adapted from the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 work system model to improve patient outcomes, a human factors engineering model developed by Holden et al. The SEIPS 2.0 model emphasizes how work system barriers can impact the “work” conducted by pharmacists and older adults. Work is defined as goal-oriented, effortful activities. For pharmacists, work would include clarifying an older adult’s medication list or determining if the older adult should self-treat their stated problem. Older adult work would include determining how often to take an OTC medication or if an OTC medication interacted with prescription medication. This model is also appropriate because it highlights the importance of collaborative work, in which pharmacists and older adults are actively engaged agents, working together to achieve their goals. These work processes in turn affect older adult, pharmacist, and organizational outcomes.
Methods
See Protocol Paper for a description of study methods
Funding:
Agency for Healthcare Research and Quality (AHRQ)
This project was supported by grant number R18HS024490 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.