The large‑scale CHARMER trial is expected to improve the safety and quality of care for older adults by reducing harmful or unnecessary medicines through effective, evidence‑based deprescribing in hospitals.
Why the research is needed?
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).
What will we do?
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, and make discussions about medicines stopping in hospital important.
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, with twenty‑two hospitals participating and a target of 24,000 patients, working alongside Health Innovation East to support implementation across the sites.
How are we working with communities, services and organisations?
We will work 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 will work with 22 hospitals to see if more medicines are stopped with our approach compared to 22 hospitals without our approach. We want to see if our approach will provide additional benefits to patients, such as preventing hospital readmissions or improving quality of life. We will calculate the cost of our approach in such a way that the government can compare it with other services.
Participating sites will be provided with templates and guidance which will allow for trusts to create local actions plans that consider their unique situations. The guidance and templates will be designed in such a way that it could be easily taken up in different hospitals and will be made freely available.
Related papers, outputs and resources
- Scott S, Atkins B, D'Costa T, Rendle C, Murphy K, Taylor D, et al. Development of the Guide to Disseminating Research (GuiDiR): A consolidated framework. Research in Social and Administrative Pharmacy. 2024 Nov;20(11):1047-57.
- Work Package 5 - Dissemination - CHARMER Study
- Read first CHARMER Highlights newsletter
- Sign up to CHARMER Highlights newsletter
Who is involved?
- Co-Principal Investigator: Professor Debi Bhattacharya, University of East Anglia
- Co-Principal Investigator: Professor David Wright, University of East Anglia
- Project Lead for Implementation: Luke Natali, Health Innovation East
- 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
Get in contact
Luke Natali, luke.natali@healthinnovationeast.co.uk.
