Community pharmacists' perceptions on providing fall prevention services: a mixed-methods study

Abstract

Background Pharmacists may contribute to fall prevention particularly by identifying and deprescribing fall risk-increasing drugs (FRIDs) in patients with high fall risk. Objective To assess community pharmacists' perceptions on providing fall prevention services, and to identify their barriers and facilitators in offering these fall prevention services including deprescribing of FRIDs. Setting A mixed-methods study was conducted with Dutch pharmacists. Method Quantitative (ranking statements on a Likert scale, survey) and qualitative data (semi-structured interviews) were collected. Out of 466 pharmacists who were invited to participate, 313 Dutch pharmacists ranked statements, about providing fall prevention, that were presented during a lecture, and 205 completed a survey. To explore pharmacists' perceptions in-depth, 16 were interviewed. Quantitative data were analysed using descriptive statistics. All interviews were audiotaped and transcribed verbatim. The capability opportunity motivation-behaviour model was applied to interpret and analyse the findings of qualitative data. Main outcome measure Community pharmacists' views on providing fall prevention. Results Pharmacists stated that they were motivated to provide fall prevention. They believed they were capable of providing fall prevention by FRID deprescribing. They perceived limited opportunities to contribute. Major barriers included insufficient multidisciplinary collaboration, patient unwillingness to deprescribe FRIDs, and lack of time. Facilitators included goal-setting behaviour, financial compensation, and skilled communication. Conclusion Despite the complex decision-making process in medication-related fall prevention, community pharmacists are motivated and feel capable of providing fall prevention. Opportunities for pharmacists to provide fall prevention services should be enhanced, for example by implementing multidisciplinary agreements.

Keywords: Accidental falls; Community pharmacy services; Decision making; Deprescriptions; Pharmacists.

Fig. 1

Application of quantitative methods (statement rankings and survey) and a qualitative method (interviews) to investigate the overall and in-depth perspectives of pharmacists. The capability opportunity motivation-behaviour (COM-B) model was applied to qualitative data. Quantitative data and qualitative data were related to each other by linking findings by means of the topics. COM-B capability opportunity motivation-behaviour model

Fig. 2

Flowchart and background characteristics of responders to the statements during the interactive research presentation, survey and inclusion of pharmacists in interviews. ^†Five pharmacists did not share background characteristics, but completed the survey. ^‡One pharmacist did not share his/her years of working experience. Q1 first quartile, Q3 third quartile, N number

Fig. 3

The topics of the interviews mapped to the domains of the capability opportunity motivation-behaviour (COM-B) model [28, 29]