title: Implementation of a community pharmacy-based falls prevention program.
abstract: BACKGROUND
  Falls are the leading cause of fatal and nonfatal unintentional injury among older adults in the United States. Multifaceted falls prevention programs, which have been reported to reduce the risk for falls among older adults, usually include a medication review and modification component. Based on a literature search, no randomized trials that have examined the effectiveness of this component have been published.
  
  
  OBJECTIVE
  The aim of this article was to report on a retrospective process evaluation of data from a randomized, controlled trial conducted to examine the effectiveness of a medication review intervention, delivered through community pharmacies, on the rate of falls among community-dwelling older adults.
  
  
  METHODS
  Patients were recruited through 32 pharmacies in North Carolina. Participants were community-dwelling older adults at high risk for falls based on age (≥ 65 years), number of concurrent medications (≥ 4), and medication classes (emphasis on CNS-active agents). The process evaluation measured the recruitment of patients into the study, the process through which the intervention was delivered, the extent to which patients implemented the recommendations for intervention, and the acceptance of pharmacists' recommendations by prescribing physicians.
  
  
  RESULTS
  Of the 7793 patients contacted for study participation, 981 (12.6%) responded to the initial inquiry. A total of 801 (81.7%) participated in an eligibility interview, of whom 342 (42.7%) were eligible. Baseline data collection was completed in 186 of eligible patients (54.4%), who were randomly assigned to the intervention group (n = 93) or the control group (n = 93). Pharmacists delivered a medication review to 73 of the patients (78.5%) in the intervention group, with 41 recommendations for changes in medication, of which 10 (24.4%) were implemented. Of the 31 prescribing physicians contacted with pharmacists' recommendations, 14 (45.2%) responded, and 10 (32.3%) authorized the changes.
  
  
  CONCLUSIONS
  Based on the findings from the present study, coordination of care between community pharmacists and prescribers needs to be improved for the realization of potential beneficial effects of medication management on falls prevention.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599-7505, USA. ccasteel@email.unc.edu
authors.forename: Carri
authors.initials: C
authors.lastname: Casteel
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Blalock
authors.forename: Stefanie
authors.initials: S
authors.lastname: Ferreri
authors.forename: Mary T
authors.initials: MT
authors.lastname: Roth
authors.forename: Karen B
authors.initials: KB
authors.lastname: Demby
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D003157:Community Pharmacy Services / Q000458:organization & administration; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D054539:Medication Therapy Management / Q000458:organization & administration; D008875:Middle Aged; D009657:North Carolina; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs / Q000009:adverse effects*; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D055553:Prescription Drugs