Abstract
Background:
Hospital deprescribing trials have demonstrated marginal increases in deprescribing activity that are not sustained beyond the trial period. The hospital deprescribing implementation framework (hDIF) links barriers and enablers of deprescribing in hospital with 44 potential intervention components. This study aimed to support geriatricians and pharmacists to select and characterise hDIF components according to affordability, practicability, effectiveness, acceptability, safety and equity (APEASE) to design a deprescribing intervention in the English hospital setting.
Methods:
We convened a modified Nominal Group Technique with a panel of nine geriatricians and pharmacists representing five English hospitals. Panel members selected and characterised intervention components from the hDIF based on the APEASE criteria. We set a consensus threshold of 80% agreement per APEASE criterion in order for the intervention component to be included.
Results
The panel selected five intervention components supporting engagement with deprescribing: an organisational action plan to prioritise deprescribing; two training activities to address pharmacists’ beliefs about negative deprescribing consequences; restructuring pharmacists’ working patterns to facilitate their contribution to deprescribing decisions; sharing experiences of successfully engaging patients/family in deprescribing conversations to support others to do the same. A sixth component was selected to sustain engagement with deprescribing through measuring and sharing deprescribing activity achieved between teams.
Conclusions:
Deprescribing interventions targeting geriatricians’ and pharmacists’ behaviour in the English hospital context should include the six characterised components. A component to sustain deprescribing activity is a notable omission from previously reported deprescribing interventions and may explain their failure to maintain efficacy beyond the short-term trial period.
Hospital deprescribing trials have demonstrated marginal increases in deprescribing activity that are not sustained beyond the trial period. The hospital deprescribing implementation framework (hDIF) links barriers and enablers of deprescribing in hospital with 44 potential intervention components. This study aimed to support geriatricians and pharmacists to select and characterise hDIF components according to affordability, practicability, effectiveness, acceptability, safety and equity (APEASE) to design a deprescribing intervention in the English hospital setting.
Methods:
We convened a modified Nominal Group Technique with a panel of nine geriatricians and pharmacists representing five English hospitals. Panel members selected and characterised intervention components from the hDIF based on the APEASE criteria. We set a consensus threshold of 80% agreement per APEASE criterion in order for the intervention component to be included.
Results
The panel selected five intervention components supporting engagement with deprescribing: an organisational action plan to prioritise deprescribing; two training activities to address pharmacists’ beliefs about negative deprescribing consequences; restructuring pharmacists’ working patterns to facilitate their contribution to deprescribing decisions; sharing experiences of successfully engaging patients/family in deprescribing conversations to support others to do the same. A sixth component was selected to sustain engagement with deprescribing through measuring and sharing deprescribing activity achieved between teams.
Conclusions:
Deprescribing interventions targeting geriatricians’ and pharmacists’ behaviour in the English hospital context should include the six characterised components. A component to sustain deprescribing activity is a notable omission from previously reported deprescribing interventions and may explain their failure to maintain efficacy beyond the short-term trial period.
| Original language | English |
|---|---|
| Pages (from-to) | 581–586 |
| Number of pages | 6 |
| Journal | Age and Ageing |
| Volume | 50 |
| Issue number | 2 |
| Early online date | 2 Sep 2020 |
| DOIs | |
| Publication status | Published - Mar 2021 |
Keywords
- behaviour change
- deprescriptions
- inappropriate medication
- older people
- secondary care
Profiles
-
Debi Bhattacharya
- School of Chemistry, Pharmacy and Pharmacology - Honorary Professor
- Patient Care - Member
Person: Honorary, Research Group Member
-
David Wright
- School of Chemistry, Pharmacy and Pharmacology - Honorary Professor
- Norwich Institute for Healthy Aging - Member
- Patient Care - Member
Person: Honorary, Research Group Member, Research Centre Member