NHS Doncaster Community Pharmacy Falls
Prevention Service Evaluation
Patients who have fallen in the past year are
referred directly to the Specialist Falls Clinic.
May 2014
Service Evaluation
Background
Aim and Objectives: To evaluate a community
pharmacy falls prevention service. To identify the
number of patients using the service, risk factors being
identified and interventions provided by community
pharmacists, exploring patient satisfaction with the
service and ideas for service development.
Falls & fall-related injuries are a common & serious
problem nationally costing an estimated £2.3 billion
annually.1
In Doncaster between April 2013 and February
2014 there were 2409 emergency admissions due
to all injuries caused by falls at a cost of
£6,463,415.2
Setting: Twenty-three community pharmacies across
Doncaster.
Methods: A mixture of research methods were used
for data collection: audit of 414 consultations, analysis
of 353 patient satisfaction questionnaires and a faceto-face meeting with a Falls Co-ordinator. Audit and
questionnaire results were analysed using descriptive
statistics, qualitative comments using a thematic
approach.
Falls and falls-related injuries have an impact on
quality of life, health and healthcare costs. People
aged 65 years and older have the highest risk of
falling, with 30% of people older than 65 and 50% of
people older than 80 falling at least once a year. 1
Consequences of falling include; fractures, head
injuries,
psychological
problems
i.e.
social
isolation/depression, disability, loss of independence,
need for long term residential/nursing home care or
even death. Falling also affects family members and
carers of people who fall.1
Limitations: Information and investigator bias, and
poor piloting and design of the data collection tools
limited the methods used.
Evaluation Results
Rationale for the new service
Overall Scheme Cost and Period Covered
Many of the risk factors for falls are potentially
modifiable and there is growing evidence of cost
effective interventions to prevent falls.3 People aged
over 65 visit pharmacies on a regular basis.
Community pharmacies are easily accessible, open at
convenient times and have private consultation areas.
With their knowledge of medicines and bone heath
community pharmacists could be effectively utilised to
provide falls and fracture prevention services.4
Total cost of the service from January-March 2014
including initial set-up/training costs and evaluation:
£6730.
A&E Attendances and Admissions Avoided
The short time period the service has been running for
and the multifactorial nature of falls make it difficult to
identify whether or not the service has had an impact
on A&E attendances/admissions.
Doncaster Local Pharmaceutical Committee (LPC)
developed a Community Pharmacy Falls Prevention
Service commissioned by NHS Doncaster using
Winter Funding. This report provides a summary of the
findings from evaluation of this new service.
Falls Risk Factors Identified
Risk Factors Identified
Percentage of Patients
Aims of the service
94.9
To address primary prevention of falls and fractures:
identifying patients at risk and preventing the first
fall/fracture. To identify patients who have fallen in the
last 12 months.
31.5
17.4
22.6
22
22.1
21.8
Community Pharmacy Falls Prevention Service
Patients aged 65 years and over taking 3 or more
medicines or ‘high-risk’ medication are targeted for a
consultation with a pharmacist who has undertaken
falls prevention training. The pharmacist takes a falls
history, identifies any ‘high-risk’ medicines, potentially
fall-inducing side effects, performs an assessment of
gait/balance and enquires about problems with
vision/continence. Patients are provided with oral falls
and fracture prevention advice and a leaflet.
The most frequently identified risk factor for falling was
‘high-risk’ medication.
1
Risk Factors and Falls in the Last Year:
Patient Feedback
Risk Factors and Falls
Recommend Service to Others…
Will make Lifestyle Changes…
Increased Knowledge of Falls…
Advice Given was Useful…
Understand more about my…
Pharmacist Spoke Clearly…
Pharmacist Explained Purpose…
Percentage of patients who have fallen in the last
12 months
65.3
22.3
42.9
31
27.8
27.6
0% 20% 40% 60% 80% 100%
Percentage of Patients
Recommendations for development/improvement
This service should be continued and developed
further to work more closely with other health
professionals,
include
service
provision
for
housebound patients and help reduce the number of
medicines being taken by older people. An
osteoporosis screening service should be developed to
complement this service to help reduce fracture rates.
Outcomes Following the Consultations
Interventions
An electronic consultation record should be developed
to reduce the paperwork burden of the service. The
type of data collected should be reviewed and the tool
thoroughly piloted to improve data collection for future
evaluation. The service should be promoted.
Percentage of Patients
Falls Clinic
Referral
94.3
28.5
GP Notified
Strongly Disagree
Feedback was positive: “the service is beneficial, it is
accessing a group of patients that might not be
accessing other services”.
Over 50% of patients who had suffered a previous
fragility fracture were not prescribed bone-sparing
medication. Thirty-seven percent of patients’
prescribed
bone-sparing
medication
reported
compliance problems.
10.2
Disagree
Uncertain
Feedback from Falls Co-ordinator
Bone Health
98.3
Agree
“Support was amazing after poor service from DRI
A&E. The pharmacy has done more to support my
falls and reduce readmission to A&E which is for
me a step in the right direction” Patient.
Statistically significant relationships were found
between fall-inducing side effects or balance/gait
problems and falling (p<0.001), with 31% of patients
experiencing potentially fall-inducing side effects and
42.9% with balance/gait problems having fallen in the
last year.
81.2
Strongly Agree
Conclusion
This evaluation has demonstrated there is a much
needed role for community pharmacists in primary falls
prevention; they can successfully identify patients at
risk, provide patient education and make appropriate
referrals to the specialist falls clinic. Funding for this
new and unique service should continue as it
addresses primary prevention of falls, which are a
common problem with serious consequences. Patient
satisfaction with the service is high, it is supported by
the specialist falls service and it is accessing patients
who are not accessing other services.
Pharmacist Oral Advice Leaflet Given
Intervention
The majority of consultations resulted in primary
prevention interventions provided by the pharmacist
indicating a low impact on GP and falls clinic workload.
A previous fall is the most significant risk factor
for falling. The 10% of patients referred to the falls
clinic by the community pharmacists are unlikely
to have been referred/had access to falls
prevention interventions and advice if this new
service had not existed.
References
1.National Institute for Health and Care Excellence Clinical Guideline
161. NICE 2013. 2. NHS Doncaster CCG 3. Moylan K.C, Binder E.F.
The American Journal of Medicine 2007;120:493-497 4.Law A.V,
Shapiro K. Journal of Evaluation in Clinical Practice 2004;11(3):247255. For further information contact: doncasterlpc@gmail.com
Patient Questionnaire Results
Patient feedback was extremely positive.
2
3