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Falls Check in community pharmacies

Promoting awareness and screening for falls risk in older adults at community pharmacies, leveraging health check stations where available.

Photo of Michael Bishop

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Who is your idea designed for and how does it enable older adults to live their best possible life by preventing falls?

Our idea is designed primarily for older adults who visit community pharmacies. Pharmacies offer several ways to screen, identify and mitigate risk factors to prevent falls in older adults at risk: pharmacists when interacting with patients or caregivers; health check stations to provide for self-assessment and supplement an interaction with a pharmacist; screen technologies to promote awareness. All of these can lead to interventions to enable older adults to live their best possible lives.

Older adults may be unaware of their increased risk of falling. There are several risk factors for falls in older adults, including having fallen in the last six months, having an unsteady gait/balance problems, or worrying about falling. Being on three or more medications also increases risk. Promoting awareness and early screening would reduce total falls and resulting injuries, which have economic and personal costs.

Community pharmacists are highly accessible healthcare professionals, well-positioned to screen for falls risk, mitigate risk factors and promote local fall prevention programs. Community pharmacy interventions for falls prevention are not new (see attached research articles: Bartlett, Casteel, Mott); however, there are various barriers to implementation, such as time and resource constraints (see attached research article: Laliberté). 

Our idea leverages pharmacist healthcare knowledge, pharmacy technology, and information dissemination to overcome barriers and provide a comprehensive intervention: 

1. Healthcare knowledge

Pharmacists can use existing falls risk assessment tools such as the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths and Injuries) toolkit. 

STEADI provides training for pharmacists to use these tools to screen older adults at risk and suggest mitigation strategies such as medication reviews to reduce falls risk. Medications that increase the risk of falls include antidepressants, antiepileptics, antipsychotics, diabetic medications, cardiovascular medications, opioids and sedatives. Pharmacists can assess the appropriateness of current medications and recommend withdrawing inappropriate prescriptions. For example, they may recommend that psychotropic medications be withdrawn gradually in those at risk of falling from excessive daytime drowsiness or dizziness. Pharmacists can also recommend simple interventions such as adding vitamin D as deficiency has been linked to increased falls risk (STEADI training, American Pharmacists Association). 

2. healthcare technologies

Some pharmacies have health check stations that could be leveraged for falls risk screening. Currently, most health check stations in pharmacies are designed to measure and monitor sitting blood pressure only. These stations could be re-designed to integrate physical falls risk screening tests and educational materials such as:

  • Including a platform with integrated force sensors that could detect sway movement and predict fall risks (stand on platform with eyes open then shut). The Wii board by Nintendo (see image below) is an example of a sensing platform technology that can assess falls (see Check Your Balance). 

  • A platform with force sensors could also sense standing motions during 30 Second Chair Stand Test, another test to assess falls risk.
  • Re-designing the machine to measure and calculate the difference between sitting and standing blood pressures to test for postural hypotension, a known risk factor for falls in older adults. 
  • A flat screen TV could provide information on testing procedures, accompany or direct subjects through tests, provide test results, and direct users to follow-up with the pharmacist. When not in use, videos and other information could be displayed on the screen and/or a gaming technology could be integrated for other kinds of testing (e.g. reflexes) or to provide a fun way to learn about health.

In pharmacies without health check stations or without space for health check stations, alternative technologies could be available to assess falls risk, such as:

  • A stand-alone platform with force sensors
  • Wearable sensor assessment technology, such at the Kinesis QTUG™ (OpenIDEO idea in refinement stage)


3. healthcare information 

Pharmacies’ information dissemination platforms could promote falls risk awareness to patients and the public. Pamphlet literature is an established way to provide information but it could also be disseminated via electronic screens, which are increasingly being integrated into pharmacy environments, in waiting and other areas.

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

A small number of community pharmacists would be approached for their opinions on STEADI's toolkit and a rough prototype or image of an enhanced health check station to identify challenges and opportunities in a community pharmacy setting. We could observe them using these tools with their patients and identify how the process of falls screening, assessment and intervention could be optimized.

What skills, input, or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

How best to structure a falls prevention program within a community pharmacy setting? What other services could be combined with falls prevention for reimbursement models (e.g. influenza vaccination programs)? What other kinds of fall-risk detection technologies or tests could be incorporated into health check stations or offered by a pharmacist? What possibilities can be found in the use of interactive TVs/screens in pharmacies?

How long has your idea existed?

  • 0-3 months

This idea emerged from

  • A group brainstorm

Tell us about your work experience:

Michael is a policy advisor working in the area of climate change policy and program design. He also practices 3D design. Nita is a pharmacist interested in design thinking to solve wicked healthcare problems. She will be pursuing a master's program in design for health at OCADU in Sept. 2017.

How would you describe this idea while in an elevator with someone?

Our idea is to have community pharmacists integrate falls risk assessment tools and technologies into their practices to identify older adults at risk of falls, disseminate information about falls prevention, and where possible intervene to reduce falls risk.

How does your idea demonstrate our Criteria of Affordability?

The risks assessment tools and technologies would available for free to all customers of community pharmacies. Technology costs would be incorporated as a very small incremental cost added to all pharmacy products. Pharmacy service costs could be mitigated by having a co-located health check station perform most if not all of the screening test, with the pharmacist playing the role of instigator, guide, and contact person if further questions arise or actions are needed.

How does your idea demonstrate or plan to demonstrate scalability?

In Ontario (Canada), the public drug program for older adults pays pharmacists to conduct Meds Checks annually on those taking 3 or more prescription medications. A Falls Check intervention could be easily added to this service. To reach more users, a Falls Check could also be combined with another annual existing service, such as influenza vaccination programs. Health check station manufacturers could adopt falls assessment technologies for their clients, working with pharmacies & others.

How do you plan to measure the impact of your idea?

• Determining the no. of pharmacists taking falls prevention training • Measuring changes in patient/caregiver awareness and actions taken to reduce falls risk • Determining the no. of Falls Checks completed on an annual basis and the no. & type of pharmacy actions taken • Measuring the no. of pharmacies with health check stations incorporating falls-risk assessment technologies • Satisfaction survey with health check station users

What are your immediate next steps after the challenge?

Approach provincial government with Falls Check idea and approach health station manufacturers to inquire about feasibility and cost of station redesign.
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Attachments (14)

FallsCheck.pdf

User journey. Design by Keith Ly.

1_konstantin_grcic.jpg

Research - design concepts: new forms; private/public designs

2_various.jpg

Research - design concepts

3_multimedia.jpg

Research - design concepts: multimedia, robots

4_telephone_booths.jpg

Research - telephone booth design: public/private space

Kwok 2015.pdf

Research article: "Novel use of theWii Balance Board to prospectively predict falls in community-dwelling older adults"

Bartlett 2015.pdf

Research article: "Pharmacist Consultations: Simplifying Daily Drug Regimens and Providing Education on Fall Risk for Older Adults"

Casteel 2011.pdf

Research article: "Implementation of a Community Pharmacy–Based Falls Prevention Program"

Mott 2014.pdf

Research article: "The Development of a Community-Based, Pharmacist-Provided Falls Prevention MTM Intervention for Older Adults: Relationship Building, Methods, and Rationale"

Laliberte 2013.pdf

Research article: "The role of community pharmacists in the prevention and management of osteoporosis and the risk of falls: results of a cross-sectional study and qualitative interviews"

Questionnaire - patient and caregiver2_summary.doc

Patient questionnaire and summary of responses. 28 May 2017.

Questionnaire - pharmacist2_answers_summary.doc

Pharmacist questionnaire and summary of responses. 20 May 2017.

journey_mapping_session.jpg

Journey mapping session at OpenIDEO Toronto Chapter, 8 May 2017.

IdeasSubmission - Detecting risks of falling at health check stations.pdf

Submission at end of Ideas phase, with openIDEO community comments.

31 comments

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Photo of Duncan Yorkston
Team

Hi Michael and Nita,
I like this idea and how it aims to expand the role of community pharmacists in the primary prevention setting. As a pharmacist who has spent a number of years working in community pharmacy, I am aware of the time constraints of this job. Without some funding I could see pharmacy owners being reluctant to engage with this program.

In Australia we have some government funding for community pharmacists to perform clinical interventions and medication checks in the pharmacy under the 6th Community Pharmacy Agreement (http://6cpa.com.au/medication-management-programmes/medscheck-diabetes-medscheck/). Does the US have any system like this?

I also note that you've written 'Pharmacists can assess the appropriateness of current medications and recommend withdrawing inappropriate prescriptions.' How would your pharmacists do this? Would they call the Dr or write a letter? This is exactly the kind of thing our team specialises in over here. In this case we would request to the Dr for one of our pharmacists to perform a home medication review (HMR) which is also funded by our health care system. Do you have home medication reviews in the US? If so, could you utilise something like this as part of your idea and offer some of the proceeds to the pharmacy owner?

Photo of Nita Lakhani
Team

Hi Duncan!

Thank you for your insightful comments. I was also a community pharmacist for a while, but in Ontario, Canada, so I can't speak for the U.S. pharmacy model. I agree that pharmacy owners would be reluctant to increase services without funding/compensation.

In Ontario, we also have government funding for clinical interventions, including Meds Check and home visits; however, although there's been significant uptake of medication reviews performed in the pharmacy, home visits are trickier given that the majority of pharmacies employ only one pharmacist without technician or assistant support (pharmacies need to have a certain prescription quota to allow for more staff). Given that there needs to be a pharmacist on site and often only one pharmacist, I suspect home visits are not frequent. Pharmacists that are part of family health teams have more flexibility to perform home visits, but not all patients are part of family health teams.

In terms of interventions, if inappropriate medications are identified, pharmacists have the option to call the physician or fax a letter. There is some reimbursement for this service as part of a Pharmaceutical Opinion program funded by the Ontario government. In either case (medication review on-site or home visit), reimbursement is provided to the pharmacy, not to individual staff directly.

Are home medication reviews routine in Australia? Who conducts the majority of these - the pharmacist or physician?

Photo of Duncan Yorkston
Team

Hi Nita,

Home medication reviews have been around in Australia for some time however only a minority of doctors would routinely seek them. Pharmacists must do extra training to be accredited to perform home medication reviews in Australia.

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