A process evaluation of a cluster randomised trial to reduce potentially inappropriate prescribing in older people in primary care (OPTI-SCRIPT study)

Abstract

BackgroundThe OPTI-SCRIPT cluster randomised controlled trial (RCT) found that a three-phase multifaceted intervention including academic detailing with a pharmacist, GP-led medicines reviews, supported by web-based pharmaceutical treatment algorithms, and tailored patient information leaflets, was effective in reducing potentially inappropriate prescribing (PIP) in Irish primary care. We report a process evaluation exploring the implementation of the intervention, the experiences of those participating in the study and lessons for future implementation.MethodsThe OPTI-SCRIPT trial included 21 GP practices and 196 patients. The process evaluation used mixed methods. Quantitative data were collected from all GP practices and semi-structured interviews were conducted with GPs from intervention and control groups, and a purposive sample of patients from the intervention group. All interviews were transcribed verbatim and analysed using a thematic analysis.ResultsDespite receiving a standardised academic detailing session, intervention delivery varied among GP practices. Just over 70 % of practices completed medicines review as recommended with the patient present. Only single-handed practices conducted reviews without patients present, highlighting the influence of practice characteristics and resources on variation. Medications were more likely to be completely stopped or switched to another more appropriate medication when reviews were conducted with patients present. The patient information leaflets were not used by any of the intervention practices. Both GP (32 %) and patient (40 %) recruitment rates were modest. For those who did participate, overall, the experience was positively viewed, with GPs and patients referring to the value of medication reviews to improve prescribing and reduce unnecessary medications. Lack of time in busy GP practices and remuneration were identified as organisational barriers to future implementation.ConclusionsThe OPTI-SCRIPT intervention was positively viewed by both GPs and patients, both of whom valued the study’s objectives. Patient information leaflets were not a successful component of the intervention. Academic detailing and medication reviews are important components in changing PIP, and having patients present during the review process seems to be a more effective approach for decreasing PIP.Trial registrationCurrent controlled trials ISRCTN41694007. Registered on 21 March 2012.

Implementation of a complex intervention to improve participation in older people with joint contractures living in nursing homes: A process evaluation of a cluster-randomised pilot trial

“…The sta ng situation was also highlighted as a context-speci c barrier for the implementation. Staff shortages and excessive workloads are often described as barriers when providing an intervention [40,54,55]. The time pressure in nursing not only affects the nurses' health-related quality of life but is also associated with a decreased quality of nursing care, and consequently, patient health outcomes [56].…”

Piloting the Integration of Non-Dispensing Pharmacists in the Australian General Practice Setting: A Process Evaluation

“…This approach may lead to overlooking important implementation elements that may have contributed to how, or why, an intervention was successful and the influence of situational context on the intervention. More recently the use of process evaluation is being increasingly recognised as a valid technique for analysing complex interventions [1213]. Conducting a process evaluation in an intervention’s pilot phase may help to identify potential issues and allow the adjustment of the interventional design to avoid future intervention outcome failure.…”

Polifarmacia en adulto mayor, impacto en su calidad de vida. Revision de literatura

“…pendiente 272 E l envejecimiento en población mundial (1)(2), constituye un acontecimientos demográficos y sociales muy relevantes en los últimos tiempos (3)(4), conlleva cambios y deterioros fisiológicos en los sistemas corporales de adultos mayores (5), haciéndolos más susceptibles al consumo de fármacos y efectos adversos (6)(7)(8), esto genera mayores ingresos hospitalarios, caídas, incontinencia de esfínteres, daño cognitivo e incluso muerte (10)(11)(12), repercutiendo en pérdida de funcionalidad para realizar actividades vitales diarias (13), disminuyendo paulatinamente la calidad de vida (14)(15). Además, las pluripatologías producen una situación de salud que demanda tratamientos prolongados y variados (16)(17), llevando al adulto mayor a polifarmacia (18)(19), la cual la Organización Mundial de la Salud (OMS) (2014), la define como "utilización de cuatro o más fármacos en forma simultánea en personas" (20).…”