Impact of a pilot community pharmacy system redesign on reducing over-the-counter medication misuse in older adults

Abstract Background No interventions have attempted to decrease misuse of over-the-counter (OTC) medications for adults older than 65 (older adults) by addressing system barriers. An innovative structural pharmacy redesign (the Senior SectionTM) was conceptualized to increase awareness of higher-risk OTC medications. The Senior Section contains a curated selection of OTC medications and is close to the prescription department to facilitate pharmacy staff/patient engagement to reduce misuse. Objective This pilot study examines the Senior Section’s effectiveness at influencing OTC medication misuse in older adults. Methods A pretest-posttest non-equivalent groups design was used to recruit 87 older adults from three pharmacies. Using a hypothetical scenario, participants selected an OTC medication, which was compared to their medication list and health conditions, and their reported use was compared against the product labeling. Misuse outcomes comprised Drug/Drug, Drug/Disease, Drug/Age, and Drug/Label with five sub-types. Patient characteristics were compiled into a propensity-score matching logistic-regression model to estimate their effects on the Senior Section’s association with misuse at pre-/post-implementation. Results Patient characteristic were uniform between pre-/post-implementation and, once entered into a propensity-score matching model, Drug/Label Misuse (Exceeds Daily-Dosage) significantly lessened over time (z=-2.42, p=0.015). In addition, the Senior Section reduced Drug/Label Misuse (Exceeds Single-Dosage) for both the raw score model (z=-6.38, p=0.011) or for the model in which the patient characteristics propensity score was added (z=-5.82, p=0.011). Despite these limited statistical effects, misuse was found to decrease after implementation for 7 of 11 comparisons. Conclusions These nascent outcomes begin providing an evidence base to support a well-conceived pharmacy-based OTC aisles redesign for reducing older adult OTC medication misuse. The Senior Section, when broadly implemented, creates permanent structures and processes to assist older adults to access risk information when selecting safer OTC medications.