Assessing deprescribing tools for implementation in care homes: A qualitative study of the views of care home staff.
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Authors
Warmoth, Krystal
Rees, Jessica
Day, Jo
Cockcroft, Emma
Aylward, Alex
Pollock, Lucy
Coxon, George
Craig, Trudy
Walton, Bridget
Stein, Ken
Issue Date
2024-04
Type
Journal Article
Language
en
Keywords
Implementation science , Long-term care , Medicine optimisation , Older adults , Polypharmacy , Qualitative study
Alternative Title
Abstract
Background: Care home residents often experience polypharmacy (defined as taking five or more regular medicines). Therefore, we need to ensure that residents only take the medications that are appropriate or provide value (also known as medicines optimisation). To achieve this, deprescribing, or the reduction or stopping of prescription medicines that may no longer be providing benefit, can help manage polypharmacy and improve outcomes. Various tools, guides, and approaches have been developed to help support health professionals to deprescribe in regular practice. Little evaluation of these tools has been conducted and no work has been done in the care home setting.
Objective: This qualitative study aimed to assess distinct types of deprescribing tools for acceptability, feasibility, and suitability for the care home setting.
Methods: Cognitive (think-aloud) interviews with care home staff in England were conducted (from December 2021 to June 2022) to assess five different deprescribing tools. The tools included a general deprescribing guidance, a generic (non-drug specific) deprescribing framework, a drug-specific deprescribing guideline/guide, a tool for identifying potentially inappropriate medications, and an electronic clinical decision support tool. Participants were recruited via their participation in another deprescribing study. The Consolidated Framework for Implementation Research informed the data collection and analysis.
Results: Eight care home staff from 7 different care homes were interviewed. The five deprescribing tools were reviewed and assessed as not acceptable, feasible, or suitable for the care home setting. All would require significant modifications for use in the care home setting (e.g., language, design, and its function or use with different stakeholders).
Conclusions: As none of the tools were deemed acceptable, feasible, and suitable, future work is warranted to develop and tailor deprescribing tools for the care home setting, considering its specific context and users. Deprescribing implemented safely and successfully in care homes can benefit residents and the wider health economy.
Keywords: Implementation science; Long-term care; Medicine optimisation; Older adults; Polypharmacy; Qualitative study.
Description
Citation
Warmoth, K.; Rees, J.; Day, J.; Cockcroft, E.; Aylward, A.; Pollock, L.; Coxon, G.; Craig, T.; Walton, B. and Stein, K. (2024) 'Assessing deprescribing tools for implementation in care homes: a qualitative study of the views of care home staff', Research in Social & Administrative Pharmacy, 20(4) pp.379-388. Available at: https://doi.org/10.1016/j.sapharm.2023.11.008
Publisher
Elsevier
License
Copyright © 2023. Published by Elsevier Inc.
Journal
Research in social & administrative pharmacy : RSAP
Volume
20
Issue
4
PubMed ID
ISSN
1934-8150