A study to refine and test a behaviour change intervention to support geriatricians and pharmacists to work with patients to deprescribe inappropriate medication in the hospital setting.
Summary
As we get older, our bodies are less able to handle some medicines. Medicines that were once effective and safe, can become less beneficial, with increased risk of harm. Half of older people in hospital are prescribed a medicine with a safety risk but these medicines are rarely stopped. Nine out of ten patients and carers believe that risky medicines should be stopped in hospital and that doctors should start the discussion. To make this happen, we need to change doctor and pharmacist behaviour so that the idea of stopping medicines in more likely to be discussed with patients.
Our research with 54 doctors and pharmacists working with older people, found one thing that helps (drawing attention to prescribers who successfully stop risky medicines) and four things that hinder (wrong belief that patients don’t want to stop, pharmacists being unavailable when stopping decisions could be made, thinking that doing nothing is safer than stopping and medicine stopping is not a hospital priority).
Project Aims
In older people's wards we aim to:
- develop our approach to increasing discussions with patients about stopping medicines by using what helps and removing what hinders
- develop a list of things that people think are important to measure when stopping medicines in hospital
- design and carry out a study testing whether our approach works and is value for money
- make discussions about medicines stopping in hospital important
- develop a way for getting our approach to be used in all hospitals
Project Activities
- It is a practitioner behaviour change intervention designed to increase proactive deprescribing.
- In the last quarter, patient recruitment for the feasibility study was completed with N=248 participating across four hospitals in England.
- Twenty-four hospitals are participating in the definitive trial with a target of n=25,000 patients.
- East of England AHSN are working with us to support implementation across the hospitals.
Methods
We will work with patients, carers, and staff from hospital and community to develop a way to change pharmacist and doctor behaviour so that risky medicines are more likely to be stopped. They will also help us to design a study comparing hospitals using our approach with hospitals carrying on as usual.
After small-scale testing, we will test our approach in 22 hospitals and see if more medicines are stopped compared to 22 hospitals without our approach. We will also see whether our approach has benefits to patients, such as preventing hospital readmissions or improving quality of life. We will also calculate the cost of our approach in such a way that the government can compare it with other services.
Four patient and public members will be fully involved throughout: from research management and design to delivery and presentation.
We have designed the study so our approach can be easily taken up in different hospitals and will make the information on how to do this freely available. Throughout the research, we will plan how and with whom to share our findings; this will be led by a public member experienced in changing national practice.
Who is involved?
Principle Investigators
Professor Debi Bhattacharya, University of East Anglia
Professor David Wright, University of East Anglia
Researchers and institutions
Mrs Kathryn Murphy, Patient and Public Involvement lead
Dr Sion Scott, University of East Anglia
Dr Allan Clark, University of East Anglia
Mr David Turner, University of East Anglia
Dr Ian Gibson, University of East Anglia
Dr Martyn Patel, Norfolk and Norwich University Hospitals NHS Foundation Trust
Professor David Alldred, University of Leeds
Dr Ian Kellar, University of Leeds
Dr Jo Taylor, University of York
Professor Miles Witham, Newcastle University
Dr Victoria Keevil, Cambridge University Hospitals NHS Foundation Trust
Disclaimer
This project is funded by the National Institute for Health Research (Programme Grants for Applied Research, NIHR200874). This is independent research supported by the National Institute for Health Research (NIHR) Applied Research Collaboration for the East of England and South West Peninsula. The views expressed are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.
