Use of pharmacy services in community-dwelling middle-aged and older adults in Ireland

Abstract

Introduction: Pharmacy has a potentially significantrole in meeting the escalating need for healthcare, particularly with population ageing and shifts to more communitybased care under Ireland's health reform policies. The roleof community pharmacists has evolved in recent years withexpansion in pharmacy services offered. This study aims toassess pharmacy services use among adults aged =50 years inIreland, and determine the demographic and clinical factorsassociated with pharmacy services use.Methods: This cross-sectional study included communitydwelling participants in wave 4 of The Irish LongitudinalStudy on Ageing (TILDA), aged =50 years who were selfrespondents (i.e. proxy respondents were omitted). TILDAis a nationally representative cohort study, and wave 4 datawas collected during 2016. TILDA participants were askedif they availed of several named services when visiting thepharmacy in the last 12 months. These included: requestingadvice about medication; vaccination; blood pressure (BP)or cholesterol checks; advice on smoking cessation or weightmanagement; and diabetes, asthma, or allergy tests. We considered age, sex, educational attainment, GP utilization,medical card and private health insurance status, loneliness,polypharmacy, use of high risk medications (anticoagulants,NSAIDs, opioids, diuretics, antiplatelets, antimicrobials, insulin and hypoglycaemics) and comorbidities. Multivariatelogistic regression was used to examine the association ofthese with reporting (i) any pharmacy service use and (ii) requesting medicines advice.Results: This study included 5,782 participants, 55.5%were female with a mean age of 68 years. 96.6% of participants (5,587) reporting visiting a pharmacy in the previous12 months, and almost one quarter of these (1,323) availedof at least one specified pharmacy service. The most commonservices reported were requesting advice about medications(786, 13.6%), blood pressure monitoring (184, 3.2%), andvaccination (166, 2.9%). Compared to those not using any services, service users were a similar age (mean 68 years), butwere taking more medications (mean 3.6 versus 2.8), weremore often female (64.1% versus 54.2%), had higher educational attainment, and had higher GP visit rates.Controlling for other factors, the following were associatedwith a high likelihood of availing of pharmacy services: femalegender (odds ratio (OR) 1.32, 95%CI 1.14-1.52), third level education (OR 1.85, 95%CI 1.51-2.27), higher rates of GP visits,private health insurance (OR 1.29, 95%CI 1.07-1.56), highernumber of medications, loneliness, and a diagnosed respiratorycondition (OR 1.42, 95% CI 1.14-1.74). The relationship between these factors and requesting medicines advice were similar.Conclusion: A high proportion of middle-aged and olderadults visit community pharmacy and a quarter avail of specified pharmacy services. Despite advances in the services offeredin pharmacies, medicines advice remains at the core of pharmacists' practice. Those on multiple medications, who may derivegreater benefit from such services, are more likely to avail ofthem. Number of GP visits was also associated with service use,suggesting patients may avail of pharmacy services as a complement, rather than a substitute, to visiting their GP. Serviceswere more often used by people who are lonely, and pharmacists should consider interventions to support these people.