Nurse Practitioner-Pharmacist Collaboration for Medication Regimen Simplification: Pilot and Feasibility Study of a New Telehealth Model of Care.

BACKGROUND: Telehealth can increase access to medical and allied health services in residential aged care facilities (RACFs). OBJECTIVES: This study investigated the feasibility of a telehealth collaborative care model involving on-site nurse practitioner and off-site clinical pharmacist to simplify complex medication regimens in RACFs. METHODS: This was a pragmatic, nonrandomized pilot and feasibility study in three Western Australian RACFs. A nurse practitioner and an off-site clinical pharmacist applied a validated five-step regimen simplification tool. The nurse practitioner identified residents who may benefit and had a desire to simplify their regimen. The nurse practitioner and pharmacist then conducted video case conferences to discuss simplification opportunities. The nurse practitioner decided which simplification opportunities to implement in consultation with residents and general medical practitioners (GPs). The primary outcome was feasibility (recruitment and retention, protocol adherence, and stakeholder acceptability). Secondary outcomes included change in the number of medication administration times per day, medication and behavioral incidents, falls and fractures, and hospitalization at 4 months. RESULTS: Telehealth collaborative care was delivered according to the protocol, with one or more simplification opportunities identified for 18 of 21 residents. The most frequent simplification opportunities involved changing a dose time or formulation. The intervention was well received by the interviewed stakeholders. At the 4-month follow-up, 47% of residents had at least one simplification recommendation implemented and one-third had a reduced number of regular daily medication administration times. Compared to the previous quarter, there was a non-significant decline in medication incidents (24%-18% of residents), behavioral incidents (48%-35%), and falls and fractures (48%-41%). No hospitalizations were reported among residents who completed follow-up. CONCLUSIONS: This nurse practitioner-pharmacist telehealth intervention was feasible and acceptable. Further adequately powered trials to detect clinical outcomes are warranted. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should actively support telehealth-enabled interdisciplinary collaboration that promotes nurse practitioner leadership and fosters partnerships with pharmacists and GPs to advance medication regimen simplification and optimize medication management processes. Such initiatives may enhance the efficiency of medication administration, improve care coordination, and strengthen medication safety within aged care environments.