The role of the community pharmacist in fall prevention: The ups and downs of implementation

Falls are increasingly common among older people. One-third of people aged ≥ 65 years falls at least once annually. Among a diversity of risk factors for falls, medication use is considered as one of great importance. At least, community pharmacists’ role in fall prevention should include the identification and adaptation of use of fall risk-increasing drugs in patients at risk of falls. In this thesis, we aimed to answer the question how pharmacists can contribute to fall prevention and how fall prevention services can be implemented, including their barriers and facilitators. Also, this thesis aimed to assess the perspectives of patients, pharmacists, and other health care providers, for the provision of pharmacy-led fall prevention services. We found that community pharmacists are currently limited involved in fall prevention. Most patients are currently unaware of that their medications could have fall risk-increasing effects. Furthermore, other health care providers, including physiotherapist, practice nurses and home care nurses, experience suboptimal collaboration with community pharmacists in fall prevention. Fortunately, pharmacists indicated they wished to be more involved. Particularly, they believed they could contribute by advising on deprescribing of fall risk-increasing drugs. The following facilitators were identified for community pharmacists to provide fall prevention care, including deprescribing of fall risk-increasing drugs: patient engagement, good multidisciplinary collaboration, knowledge about fall risk-increasing drugs and deprescribing, and sufficient pharmacist communication skills. Lack of time and lack of reimbursement were often identified as barriers for implementation. To identify patients at medication-related fall risk more quickly, a contra-indication ‘fall risk’ could be added for saving in pharmacy information systems. This may support the screening of patients at risk, so targeted advice can be provided to them. Pharmacy technicians could be trained to identify patients at risk of falls and advise them on fall prevention accordingly. Therefore, pharmacy technicians can have an important role in the provision of pharmacy-led fall prevention services. Health care providers in primary care should be stimulated to make agreements with one another. Such agreements should be about coordination of care, multidisciplinary meetings, referral, role clarification, and manners of communication. Pharmacists might need additional training in communication techniques, in order to foster the collaboration in fall prevention. They also need good communication skills to engage their patients in fall prevention. Specifically, pharmacists should be recommended to warn patients proactively against fall-related adverse effects. In conclusion, falling in older people is a major public health issue. Pharmacists are in the position to contribute to fall prevention. The most obvious way for community pharmacists to contribute is by providing medication reviews and advising on deprescribing of FRIDs. Pharmacists should, however, take up the gauntlet and increase their visibility in fall prevention. Policy makers, professional organizations and payers should recognize and facilitate pharmacists in this role.