Strengths and limitations
cognitive impairment
Missing from our study are the resident and relatives’ opinions of medication review and the place of the pharmacist in this. We attempted to recruit the residents consented to the intervention arm of the trial through CH staff. It is unclear why this was unsuccessful with only three residents expressing an interest, but in part it is likely to be due to the severe cognitive impairment many residents were living with, meaning staff may not have actively encouraged residents or their families to take part in a process evaluation interview. A further point to note is that the sample, while appearing representative of the main trial sample, consists of those who volunteered for the additional process evaluation interview so may not represent the views of those who declined. This point along with the limited number of participants represented in a small number of codes means that the transferability of the data needs to be considered with caution as the results provide insights and understandings from a very specific group of HSCPs involved in supporting older resident CHs. All pharmacists were independent prescribers, and all had received additional training in medicine for older people. It cannot be assumed that more generalist pharmacists in a GP surgery would have the experience to make the specialised medicine management decisions demonstrated by these pharmacist independent prescribers who had received additional training. There are recommendations to make CH pharmacists a designated specialty.The CHIPPS RCT found the fall rate risk ratio for the intervention group compared with the control group was not significant. However, the Drug Burden Index outcome significantly favoured the intervention.There are practice implications for other roles within the wider healthcare team. For example, during interviews, PIPs referred to their work with community pharmacists, describing the community pharmacist position as key in dispensing medicines. Future work exploring medicines management in CHs might include the community pharmacist or dispensing pharmacy so that the efficiency of medicine ordering and dispensing can be further optimised. This might reduce the potential safety risk, reported in this study, which occurs when medicines which have been deprescribed remain on the MAR chart.The CHIPPS process evaluation was completed in 2020 just as primary care networks (PCN) were being introduced in England and at the start of the COVID-19 pandemic. A key aspect of the role was the presence of the pharmacy within the CH, the move to more ‘on-line’ working since the COVID-19 pandemic may make this aspect of the intervention more difficulty to implement. Within PCNs, pharmacists work across several GP practices rather than being within a single practice.