OBJECTIVES:The Royal Pharmaceutical Society has developed a new curriculum and credentialling process for advanced pharmacist practice. The aim of this study was to understand the self-reported advanced practice capability of UK pharmacists using this curriculum. METHODS:The study was a cross-sectional electronic survey. The inclusion criterion was that the participants be registered pharmacists practising in the UK in any professional sector. Participants rated, on a 5-point Likert scale, their confidence that their current practice aligns to the described level in the Royal Pharmaceutical Society Core Advanced Curriculum. Predictors of overall confidence that their current practice aligned to all curriculum outcomes were analysed using binomial regression. KEY FINDINGS:Nine hundred and eighty-eight pharmacists participated. The median age was 42 years; 75.2% were female and the median length of registration was 17 years. A low proportion of pharmacists reported confidence across all outcomes (19.8%). The research domain had the lowest self-reported confidence (26.9%). Other domains had higher levels of reported confidence: professional practice (40.9%); leadership and management (43.8%); person-centred care and collaboration (54.3%); and education (57.6%). The strongest predictors of overall confidence across the whole curriculum were completion of an advanced clinical assessment skills module, being a frequent prescriber, and self-identifying as an advanced practice pharmacist. CONCLUSION:Only a minority of respondents self-reported confidence across the whole Core Advanced Curriculum. A strategy to develop and embed four pillar working for all pharmacists, as well as approaches to address systemic barriers for those working less than full-time may help deliver more 'advanced practice-ready' pharmacists.

Polypharmacy is prevalent in older people residing in care homes. Deprescribing, reducing or stopping harmful or unnecessary medicines, leads to improvements in patient- and health-system-orientated outcomes. This study identified the barriers and enablers to pharmacists proactively deprescribing in United Kingdon care homes. It draws on methods from behavioural science. Twenty-nine participants who had previously taken part in a deprescribing randomised control trial (sixteen pharmacists, six primary care doctors, and seven care home managers) were interviewed. Data were mapped to the Theoretical Domains Framework to understand pharmacists’ deprescribing behaviour. Barriers were deprescribing seen as risky and perceived resistance to deprescribing by residents, their families, and care home staff. Enablers were seeing benefits from deprescribing, part of a pharmacists’ role, and endorsement from a doctor. Ways to change pharmacist behaviour were identified from a suite of behaviour change techniques (BCT). Using a modified Nominal Group Technique, 15 staff (six pharmacists, five primary care doctors, and four care home managers) naïve to deprescribing interventions completed an online survey to assess the feasibility and acceptability of implementing the 27 BCTs. Seven BCTs achieved a more that 80% consensus on all implementation criteria. In a consensus workshop, the staff group discussed practical ways the BCTs might work in primary care practice. Fourteen UK policy and practice leaders worked with the researchers to develop recommendations from the consensus workshop into a policy briefing. In conclusion, this study provides detail on using a theory-informed approach to translate research into policy to inform deprescribing practices.

La declaración de Granada fue el resultado de la necesidad de fortalecer la farmacia práctica clínica, social y administrativa como un área de conocimiento que se materialice en la práctica, la investigación y la política. Para ello, un grupo de editores de revistas de farmacia práctica, clínica y social puso en marcha en el año 2022 en Granada una iniciativa para discutir formas de mejorar la calidad de las publicaciones en esta área, y que culminó en el documento denominado Declaración de Granada. Se desarrollaron dieciocho recomendaciones, agrupadas en seis ámbitos principales: 1) uso apropiado de la terminología; 2) elaborar resúmenes impacto 3) necesidad de las revisiones por pares; 4) limitar la dispersión de revistas; 5) uso más efectivo y adecuado de las métricas de impacto de revistas y artículos; y 6) selección por los autores de la revista de farmacia práctica más apropiada para publicar su trabajo. La declaración de Granada ha sido publicada íntegramente en 14 revistas. Este documento pionero tiene sus antecedentes en otras iniciativas similares desarrolladas por académicos de otros grupos de profesiones de la salud, fomentando el concepto de consenso interdisciplinar y avanzando en el paradigma científico.

Abstract We are delighted to publish the abstracts presented at the Royal Pharmaceutical Society (RPS) Annual Conference 2024 in this International Journal of Pharmacy Practice Issue Supplement. The conference entitled ‘Working across boundaries: Embracing new opportunities and empowering excellence’ included the themes of: Enhancing patient care; Advancing the workforce; Science & Research; and Your RPS. It was held both online and in person at Convene, 133 Houndsditch, London on 8 November 2024. As the flagship event for the RPS, the conference hosted a full day of discussions centred on the topic of cross-boundary working, from dealing with medicines shortages, to prescribing and clinical supervision, to the strategic work of the RPS, and finally to innovations and research that will be shaping practice. The morning’s keynote presentation was delivered by Dr Liz O'Riordan, a breast oncology surgeon who herself has had breast cancer three times, speaking on the topic of high-quality care from the perspectives of being both a medical doctor and a patient. The conference also included a keynote panel discussion in the afternoon with the four of the United Kingdom’s Chief Pharmaceutical Officers, namely David Webb (NHS England), Andrew Evans (Welsh Government), Cathy Harrison (Northern Ireland), and Alison Strath (Scotland). The event included a multitude of research and innovation presentations, as posters and orals, many published as abstracts herewith. We were particularly pleased to see the return of five oral research presentations selected from the submitted abstracts, covering a breadth of methodologies. We would like to acknowledge all those who have contributed to making this event happen, in particular members of the conference steering committee co-chaired by Helen Chang and Anna Pielach at the RPS; Leah Burton and Lauren Ross from the RPS Science and Research team who managed the abstract processes; Dr Christopher Martin and Dr Diane Ashiru-Oredope, also from the RPS Science and Research team, who joined the Conference Abstract Review Panel; Science and Research Committee members who joined us on the Conference Abstract Review Panel, namely Dr Mar Estupiñan Fdez. de Mesa, Dr Andy Fox, Prof. Amira Guirguis, Dr Gillian Hawksworth, Prof. Delyth James, Dr Rachel Palmer, and Dr Ka-Wai Wan, as well as additional members of the Conference Abstract Review Panel, including Dr Paul Forsyth, Ola Howell, Dr Louise Hughes, Dr Matthew Ivory, Prof. Catriona Mathieson, Prof. Hamde Nazar, Prof. Philip Rogers, Dr Julian Smith, and Dr Sara Visram. In common with previous years, this Supplement has been prepared ahead of the conference, so that it is ready in time. Simon White, Cathrine McKenzie, Christine Bond, Amira Guirguis, and Parastou Donyai Simon White, Deputy Chair of the RPS Science and Research Committee and co-Chair of the Conference Abstract Review Panel Keele University Cathrine A McKenzie, member of the RPS Science and Research Committee and co-Chair of the Conference Abstract Review Panel University of Southampton Christine Bond, Editor-in-Chief of the International Journal of Pharmacy Practice, member of the RPS Science and Research Committee and co-Chair of the Conference Abstract Review Panel University of Aberdeen Amira Guirguis, Chair of the RPS Science and Research Committee Swansea University Parastou Donyai, RPS Chief Scientist The Royal Pharmaceutical Society

Background: Anticholinergic burden (ACB) from medications has been associated with adverse outcomes in older adults. Aim: The aim was to conduct a non-randomized feasibility study of an intervention to reduce the anticholinergic burden in older patients (REGENERATE) to inform a subsequent definitive trial. Methods: The development and evaluation of an ACB reduction intervention was guided by the Medical Research Council framework. Findings from preliminary studies, two systematic reviews, and two qualitative studies informed the design of a mixed-method feasibility study. The study was conducted in one UK primary care site. The clinical pharmacist identified and invited potentially eligible patients, reviewed their medications, and made recommendations to reduce the ACB as needed. Patients completed surveys at baseline and 6 and 12 weeks post-intervention. A purposive sample of patients and healthcare professionals was interviewed. Results: There was a response of 16/20; 14/16 attended the pharmacist-led consultation and completed the baseline questionnaire, and 13/14 completed both follow-up questionnaires. The sustainability of deprescribing was confirmed. The results suggest the potential of the intervention to reduce side effects from medications and improve quality of life (EQ-5D-5L). The interviews showed patients were happy with the study processes and the medication changes and were satisfied with the pharmacist’s consultation. Conclusions: This feasibility study demonstrated that a deprescribing/reducing ACB intervention in older adults is feasible in a primary care setting and may benefit patients. Well-designed RCTs and cost-effectiveness studies should be undertaken to confirm the benefits of ACB deprescribing in primary care settings.

OBJECTIVES:A recent applicability study highlighted the need for the existing checklist for reporting research using a simulated patient methodology (CRiSP) to be clearer and user-friendly. The aim of this study was to update the checklist to address these concerns. METHODS:A fourth round of the Delphi consensus study, used in the original checklist development work, was conducted. Previous participants, who had expertise in SP methodology, were invited to complete a questionnaire including a list of 13 checklist items developed in the previous study and revised following applicability testing. Closed questions were analysed for frequency. Consensus was predefined as >80% agreement. All items were discussed in a roundtable meeting and further modified as necessary. Responses to open questions were content analysed. KEY FINDINGS:Twenty-one authors participated. There was a statistical consensus in 12 out of 13 modified checklist items. CONCLUSIONS:A final reporting checklist for studies in health research using SP methodology has been developed using a consensus approach. Further refinements may be needed to increase the generalizability of the checklist in different contexts.

Background Medication review (MR) is the systematic assessment of a patient's medications for safety and effectiveness by a healthcare professional. The language used to describe MR activity, such as stopped medicine and increased dose, should be consistent across studies to assist researchers compare how different services operate and identify their mechanism of impact.Aim To develop an international taxonomy of standardized terms and activity definitions related to medication reviews.Method This was a three-stage Delphi-based consensus study with international medication review experts. A systematic review provided MR activity terms for the survey. Experts rated their consensus on each activity term and its definition on a Likert scale and provided written feedback. The consensus was 75% panel agreement. At each stage, consensus elements were retained, and feedback was used to revise definitions.Results Seven experts were recruited for the study (response rate 15.2%) from four countries: the United Kingdom (n = 4), New Zealand (n = 1), Australia (n = 1), and Malaysia (n = 1). The following terms achieved consensus: the term Medication as a descriptor for MR terms; discontinue medication, start medication, dose increase, dose decrease, dosage form change, and medication safety and efficacy monitor to describe MR activity; Educate to describe the delivery of healthcare professionals and patients/carers education.Conclusion Standardized medication review activity terms and definitions have been selected for universal adoption in all future MR research to facilitate a meaningful comparison of process evaluations within different settings.

Resumen:The Granada statements were a result of the need to strengthen clinical, social and administrative pharmacy practice as an area of knowledge that translates into practice, research and policy. As a re-sponse, a group of clinical and social pharmacy practice journal editors launched an initiative in Grana-da in 2022 to discuss ways to improve the quality of publications in this area, which culminated in the Granada statements. Eighteen statements were developed, clustered into six main domains:1) the ap-propriate use of terminology; 2) developing impactful abstracts; 3) having the required peer reviews; 4) preventing journal scattering; 5) more effective and wiser use of journal and article performance met-rics; and 6) authors' selection of the most appropriate pharmacy practice journal to submit their work.The full Granada statements have been published in 14 journals.(1-14) These pioneering statements are rooted in similar endeavors undertaken by scholars in other health professions groups, fostering the concept of interdisciplinary consensus and advancing scientific paradigm.

Abstract Background Medication review (MR) is the systematic assessment of a patient’s medications for safety and effectiveness by a healthcare professional. The language used to describe MR activity, such as stopped medicine and increased dose, should be consistent across studies to assist researchers compare how different services operate and identify their mechanism of impact. Aim To develop an international taxonomy of standardized terms and activity definitions related to medication reviews. Method This was a three-stage Delphi-based consensus study with international medication review experts. A systematic review provided MR activity terms for the survey. Experts rated their consensus on each activity term and its definition on a Likert scale and provided written feedback. The consensus was 75% panel agreement. At each stage, consensus elements were retained, and feedback was used to revise definitions. Results Seven experts were recruited for the study (response rate 15.2%) from four countries: the United Kingdom (n = 4), New Zealand (n = 1), Australia (n = 1), and Malaysia (n = 1). The following terms achieved consensus: the term Medication as a descriptor for MR terms; discontinue medication, start medication, dose increase, dose decrease, dosage form change, and medication safety and efficacy monitor to describe MR activity; Educate to describe the delivery of healthcare professionals and patients/carers education. Conclusion Standardized medication review activity terms and definitions have been selected for universal adoption in all future MR research to facilitate a meaningful comparison of process evaluations within different settings.

BackgroundThe Medical Subject Headings (MeSH) thesaurus is the controlled vocabulary used to index articles in MEDLINE. MeSH were mainly manually selected until June 2022 when an automated algorithm, the Medical Text Indexer (MTI) automated was fully implemented. A selection of automated indexed articles is then reviewed (curated) by human indexers to ensure the quality of the process.ObjectiveTo describe the association of MEDLINE indexing methods (i.e., manual, automated, and automated+curated) on the MeSH assignment in pharmacy practice journals compared with medical journals.MethodsOriginal research articles published between 2016 and 2023 in two groups of journals (i.e., the Big-five general medicine and three pharmacy practice journals) were selected from PubMed using journal-specific search strategies. Metadata of the articles, including MeSH terms and indexing method, was extracted. A list of pharmacy-specific MeSH terms had been compiled from previously published studies, and their presence in pharmacy practice journal records was investigated. Using bivariate and multivariate analyses, as well as effect size measures, the number of MeSH per article was compared between journal groups, geographic origin of the journal, and indexing method.ResultsA total of 8,479 original research articles was retrieved: 6,254 from the medical journals and 2,225 from pharmacy practice journals. The number of articles indexed by the various methods was disproportionate; 77.8% of medical and 50.5% of pharmacy manually indexed. Among those indexed using the automated system, 51.1% medical and 10.9% pharmacy practice articles were then curated to ensure the indexing quality. Number of MeSH per article varied among the three indexing methods for medical and pharmacy journals, with 15.5 vs. 13.0 in manually indexed, 9.4 vs. 7.4 in automated indexed, and 12.1 vs. 7.8 in automated and then curated, respectively. Multivariate analysis showed significant effect of indexing method and journal group in the number of MeSH attributed, but not the geographical origin of the journal.ConclusionsArticles indexed using automated MTI have less MeSH than manually indexed articles. Articles published in pharmacy practice journals were indexed with fewer number of MeSH compared with general medical journal articles regardless of the indexing method used.

Zweck: Die Entwicklung einer neuartigen digitalen Intervention zur Optimierung der Schmerzkontrolle bei Krebs im lokalen Umfeld. In diesem Artikel werden die Interventionsentwicklung, der Inhalt/die Begründung und die anfängliche Machbarkeitsprüfung beschrieben. Methoden: Determinanten der suboptimalen Schmerzbehandlung bei Krebs wurden durch zwei systematische Übersichten charakterisiert; Interviews mit Patienten, Pflegekräften und Angehörigen der Gesundheitsberufe (HCP) (n = 39); und zwei HCP-Fokusgruppen (n = 12). Das Interventionsmapping wurde verwendet, um die Ergebnisse in theoriebasierte Inhalte zu übersetzen und die App «Can-Pain» zu erstellen. Patienten mit/ohne verbundene Pflegekraft, ihre Hausärzte und vor Ort ansässige Palliativ-Pflegekräfte wurden für den Machbarkeitstest Can-Pain über 4 Wochen rekrutiert. Ergebnisse: Die Patienten, die starke Opioide einnahmen, beschrieben die Herausforderungen, das Schmerzniveau mit der Opioid-Aufnahme, den Nebenwirkungen und den Aktivitäten in Einklang zu bringen und mit den Ärzten über Probleme bei der Schmerzbehandlung zu kommunizieren. Can-Pain adressiert diese Herausforderungen durch Aufklärungsressourcen, gleichzeitige kurzwirksame Opioid-Verfolgung und wöchentliche Überwachung der von den Patienten berichteten Ergebnisse. Zu den neuartigen Aspekten von Can-Pain gehört die Verwendung zeitgleicher bahnbrechender analgetischer Berichte als Ersatz für die Schmerzkontrolle und die Messung des Ausmaßes, in dem der Schmerz für den Einzelnen störend wird. Die Patienten fühlten sich aufgrund von fortgeschrittenem Krebs unwohl, was die Rekrutierung für Machbarkeitstests erschwerte. Zwei Patienten und eine Pflegekraft verwendeten Can-Pain für 4 Wochen und teilten wöchentliche Berichte mit vier Ärzten. Can-Pain machte auf unerkannte Probleme aufmerksam, förderte das gemeinsame Verständnis von Patienten und HCPs über die Symptome und unterstützte die gemeinsame Entscheidungsfindung. Schlussfolgerungen: Vorläufige Tests deuten darauf hin, dass Can-Pain machbar ist und eine patientenzentrierte Schmerzbehandlung fördern könnte. Wir werden weitere Evaluierungen in kleinem Maßstab durchführen, um eine künftige randomisierte, stufenweise Studie durchzuführen. Studienregistrierung Qualitative Forschung: ClinicalTrials.gov, Referenz-Nr. NCT02341846 Machbarkeitsstudie: NIHR CPMS-Datenbank-ID 34172

Box 1. Fictionalised examples of challenges accessing medication in the Falkland Islands, Australia, and the UKJane Smith is a 45-year-old woman who lives in a small settlement in the south of West Falkland Island, a remote island with fewer than 200 residents and no healthcare facilities.She calls the Falkland Islands' only emergency department as she has felt unwell for the last 9 days with ear pain, a sore throat, and dizziness.She is advised to obtain clarithromycin tablets from the medical chest located near her and given advice and safety netting over the phone.She is then booked into a face-to-face appointment with the doctor on their next visit to her part of the island.She visits the 'chest holder' and is given the medication.The pharmacist then organises re-supply of these medications to the medicine chest holder.They are delivered on a routine flight the next day.Marie is a 40-year-old farmer who lives 30 minutes' drive from a small rural Australian town.She has had symptoms of a urinary tract infection for several days.She decides late in the afternoon that she needs to see a GP.She receives a call back from a doctor based in Melbourne.The doctor prescribes antibiotics and suggests that she start taking them immediately.She asks whether she wants an electronic prescription sent to her phone or to the local chemist.As Marie would face a 90-minute drive to collect medication, she delays starting until she can collect more locally the next day.Seema Patel is an 88-year-old who lives in a small town in the UK.She has become increasingly frail over recent months.Both she and her family believe that she is dying.Her daughter calls 111 on a Friday evening as she is in pain.The out-of-hours GP attends, gives a stat dose of diamorphine, and issues a prescription for further end-of-life medication for the family to collect the next morning.Her son spends the morning driving around nearby pharmacies attempting to source the medication.He returns at 2 pm, by which stage his mother is no longer able to communicate.Seema dies 2 days later.The family feel she was comfortable but her son is deeply distressed that he was not present for the last morning that she was able to communicate.

INTRODUCTION:Chronic pain is a common, multifactorial condition and pharmacological treatments have limited benefits. Mindfulness is a holistic approach that might be of value in the management of chronic pain. However, attrition rates from mindfulness-based interventions are high and factors affecting engagement are unknown. The aim of this study was to inform the design of a mindfulness programme that would be accessible and acceptable for people with chronic pain.METHODS:Interpretative phenomenological analysis of interview data from people with chronic pain who had taken part in an 8-week mindfulness programme based on mindfulness-based stress reduction revealed factors affecting engagement with and suggestions for tailoring the programme. Factors were grouped into physical, psychological and social domains. Further suggestions for tailoring the programme to address these factors were generated through a nominal group of healthcare professionals and a focus group with service users who had chronic pain.FINDINGS:Physical factors included disability and discomfort with some practices; psychological factors included expectations of the mindfulness programme and understanding the relationship between mindfulness and pain; and social factors included loneliness and support from others. The proposed modifications to the mindfulness programme supported by healthcare professionals and/or service users to address these are described in this paper.PUBLIC CONTRIBUTION:This study involved public contributions at a number of stages. The University of Aberdeen Division of Applied Health Sciences Service User Group (who were members of the public with chronic pain) was involved in the design of the study. Patients with chronic pain recruited from general medical practice who took part in the mindfulness programme were interviewed on their experience of the programme. Patients with chronic pain who attended the mindfulness programme, and healthcare professionals with expertise in chronic pain and/or mindfulness, attended meetings to design a tailored mindfulness programme for people with chronic pain.

Background Omission of pelvic examination (PE) has been associated with diagnostic delay in women diagnosed with gynaecological cancer. However, PEs are often not carried out by GPs. Aim To determine the perceptions of GPs about the role of PEs, the barriers to and facilitators of PEs, and GPs experience of PEs in practice. Design and setting Qualitative semi-structured interview study conducted in one health board in Scotland (mixed urban and rural) with an approximate population of 500 000. Method Interviews were conducted face-to-face or by telephone between March and June 2019. Framework analysis used the COM-B behaviour change model concepts of capability, opportunity, and motivation. Results Data was compatible with all three domains of the COM-B framework. Capability related to training in and maintenance of skills. These went beyond carrying out the examination to interpreting it reliably. Opportunity related to the clinical environment and the provision of chaperones for intimate examination. Interviewees described a range of motivations towards or against PEs that were unrelated to either capability or opportunity. These all related to providing high-quality care, but this was defined in different ways: doing what is best for the individual, doctors examine, and GPs as pragmatists. Conclusion GPs reasons for carrying out, or not carrying out, PEs in women with symptoms potentially indicating cancer are complex. The COM-B framework provides a way of understanding this complexity. Interventions to increase the use of PEs, and critics of its non-use, need to consider these multiple factors.

Researchers working in the field, the places where research-relevant activity happens, are essential to recruitment and data collection in randomised controlled trials (RCTs). This study aimed to understand the nature of this often invisible work. Data were generated through an RCT of a pharmacist-led medication management service for older people in care homes. The study was conducted over three years and employed seven Research Associates (RA) working in Scotland, Northern Ireland, and England. Weekly research team meetings and Programme Management Group meetings naturally generated 129 sets of minutes. This documentary data was supplemented with two end-of-study RA debriefing meetings. Data were coded to sort the work being done in the field, then deductively explored through the lens of Normalization Process Theory to enable a greater understanding of the depth, breadth and complexity of work carried out by these trial delivery RAs. Results indicate RAs helped stakeholders and participants make sense of the research, they built relationships with participants to support retention, operationalised complex data collection procedures and reflected on their own work contexts to reach agreement on changes to trial procedures. The debrief discussions enabled RAs to explore and reflect on experiences from the field which had affected their day-to-day work. The learning from the challenges faced in facilitating care home research may be useful to inform future research team preparation for complex interventions. Scrutinising these data sources through the lens of NPT enabled us to identify RAs as linchpins in the successful conduct of a complex RCT study.

Free accessAbstractFirst published online June 9, 2023BPS ASM 2023 abstract supplementVolume 17, Issue 1_supplhttps://doi.org/10.1177/20494637231177771

Background Medicine prescribing, monitoring and administration in care homes can be significantly enhanced. Effective interventions to improve pharmaceutical care and resident outcomes are required. The enablement of pharmacists to prescribe provides an opportunity for pharmacist independent prescribers to assume responsibility for improving pharmaceutical care, medication-related outcomes and resident safety whilst reducing general practitioner workload. Objective(s) To determine the effectiveness and cost-effectiveness of pharmacist independent prescribing in care homes. Design Development work was undertaken through five work packages before the delivery of the definitive trial. Triads of pharmacist independent prescribers, care home and general practice with responsibility over 20 care home residents were recruited and cluster randomised to intervention or usual care for 6 months. Researchers were blinded at recruitment stage only. Recruitment of 880 residents was required to provide 80% statistical power, to show a 21% reduction in falls over 6 months, assuming 20% attrition. Randomisation was undertaken electronically at triad level, stratified by geographical area. Intention-to-treat analysis undertaken using a negative binomial model. Parameters were estimated using a generalised estimating equation approach. Costs were captured from an NHS perspective. Quality of life (EuroQol; five domain; five level) was collected by proxy to enable cost/quality-adjusted life-year estimation. A concurrent process evaluation was performed. Safety was monitored through a review of pharmacist independent prescriber activities, independent concerns reporting and review of adverse events. Participants Forty-nine triads of general practitioners, pharmacist independent prescribers and care homes were recruited with 454 residents allocated to the intervention arm and 428 to the control arm. Intervention Medication review and care planning, medication reconciliation, staff training, support with care home medication-related procedures, deprescribing and authorisation of monthly prescriptions. Main outcome measure Fall rate per person over 6 months. Results Data for 449 intervention and 427 control residents available for final analysis. The 6-month fall rate ratio in favour of intervention was 0.91 (95% confidence interval 0.66 to 1.26; p=0.58). No significant difference in secondary outcomes was identified except Drug Burden Index (rate ratio 0.83, 95% confidence interval 0.75 to 0.92; p<0.001). No harms were identified. One quarter of medication-related interventions were associated with a reduced risk of falls. The intervention was positively received. Limitations Participant self-selection bias may have affected the generalisability of findings. Open-label cluster randomised controlled trial limited by 6-month follow-up. Potential ceiling effect due to concurrent pharmacist-led interventions. Falls potentially insufficiently proximal to the intervention. Conclusions To enhance effectiveness and acceptance of the proposed model, effective integration into care home and general practitioner teams was identified as a central requirement. A core outcome set and a training package were developed. The final model of care, whilst being safe and well received and resulting in a reduction in drug burden, demonstrated no improvement in the primary outcome of falls. With no improvement in quality-adjusted life-years identified, the pharmacist independent prescriber intervention was not estimated to be cost-effective. Future work To develop and evaluate better models of care for enhancing medication outcomes and safety in care homes or re-test with a longer intervention and follow-up period and a stronger primary outcome. Trial registration This trial is registered as ISRCTN10663852, definitive trial: ISRCTN17847169. Study registration This study is registered as PROSPERO CRD20150907. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: RP-PG-0613-20007) and is published in full in Programme Grants for Applied Research; Vol. 11, No. 10. See the NIHR Funding and Awards website for further award information.