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
Project Activities
- The project is a practitioner behaviour change intervention designed to increase proactive deprescribing, we have recently completed the feasibility study across four hospitals in England and have now started the definitive trial.
- Twenty-two hospitals are participating in the definitive trial with a target of n=24,000 patients working alongside Health Innovation East to support implementation across the sites.
Methods
We have worked with patients, carers, and staff from hospital and community to develop ways to support pharmacists and doctors to have conversations with patients and carers about stopping risky medicines. Following small-scale testing we are now working with 22 hospitals to see if more medicines are stopped with our approach compared to 22 hospitals without our approach. We are also seeing if our approach provides additional 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.
Participating sites have been provided templates and guidance which will allow for trusts to create local actions plans that consider their unique situations. The guidance and templates have been designed in such a way that it can be easily taken up in different hospitals and will be made freely available.
Who is involved?
Principle Investigators
Luke Natali, Health Innovation East
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.
