Co-design of a behaviour change intervention to equip geriatricians and pharmacists to proactively deprescribe medicines that are no longer needed or are risky to continue in hospital

Scott, Sion; Atkins, Bethany; Kellar, Ian; Taylor, Jacqui; Keevil, Victoria L.; Alldred, David P.; Murphy, Katherine; Patel, Martyn; Witham, Miles; Wright, David; Bhattacharya, Debi

doi:10.1016/j.sapharm.2023.02.003

Cited by 5 publications

(4 citation statements)

References 40 publications

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“…PPI will assist the research team to map the behavioural determinants this scoping review finds to the Theoretical Domains Framework (44). We will adopt the PPI model used in the CompreHensive geriatrician-led Medication Review (CHARMER) (45) which authentically embeds PPI into the research team, and we will evaluate PPI involvement using the Public Involvement Impact Assessment Framework (PiiAF) (46).…”

Section: Patient and Public Involvementmentioning

confidence: 99%

What is known about the determinants of developing antipsychotic-induced metabolic syndrome and interventions to address them for community dwelling adults: a scoping review protocol

Good

Bhattacharya

Scott

2023

Preprint

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IntroductionAntipsychotics are the primary treatment for severe mental health conditions. Whilst antipsychotics are effective at improving psychiatric outcomes, approximately 80% of people will experience metabolic syndrome (MS), characterised by weight gain, lipid disturbance and glucose dysregulation. Antipsychotic-induced MS is associated with a two-fold increased risk of developing coronary heart disease and a five-fold risk of developing type 2 diabetes.Gender, ethnic background, age, and family history are reported non-modifiable determinants of developing antipsychotic-induced MS and provide an indication of who is at highest risk. However, it is not clear what is known about which determinants are most significant to inform targeting interventions for high-risk individuals.Antipsychotics induce an increase in calorie intake and sedentary behaviour changes, which have been linked to MS. Behavioural determinants are modifiable and provide potential intervention targets, however, the extent to which they have been studied and targeted is unclear.Non-pharmacological interventions target behavioural determinants, and the literature describes the testing of their application to prevent and treat antipsychotic-induced MS. Few studies report clinically significant attenuation of MS, and the preferred healthcare setting to deliver an intervention is yet to be established.Methods and AnalysisThis review will adhere to the Joanna Briggs Institute guidance for scoping reviews and the PRISMA-ScR checklist. Relevant electronic databases and grey literature will be searched. Qualitative, quantitative and mixed method study designs, and evidence syntheses will be considered. Two reviewers will independently screen titles and abstracts; full text screening will be undertaken by one reviewer with a 10% sample checked by another. Data will be extracted and synthesised to address the research objectives.DiscussionThis review will scope and describe the evidence about what is known about the modifiable and non-modifiable determinants of developing antipsychotic-induced MS in community dwelling adults, the non-pharmacological interventions that have previously been implemented to prevent and/or treat antipsychotic-induced MS, and the preferred context for delivery of such interventions. The review will highlight gaps in knowledge and help inform future research. The findings will be disseminated via publication in peer-reviewed journals.

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Section: Patient and Public Involvementmentioning

confidence: 99%

What is known about the determinants of developing antipsychotic-induced metabolic syndrome and interventions to address them for community dwelling adults: a scoping review protocol

Good

Bhattacharya

Scott

2023

Preprint

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“…This protocol describes the methodology used to undertake the CHARMER Work Package 3 feasibility study. Previous work packages involved establishing a core outcome set (COS) for hospital deprescribing trials12 and co-designing the CHARMER intervention 11. Work Package three will test the feasibility and acceptability of delivering and evaluating the intervention in hospitals in England.…”

Section: Introductionmentioning

confidence: 99%

“… 9 The development of the CHARMER intervention departs from existing interventions, 8 by integrating evidence regarding the determinants that require addressing and utilising behaviour change theory to design components to address them. CHARMER intervention components were selected 10 and co-designed 11 to address the prioritised barriers and enablers to geriatricians’ and pharmacists’ proactively deprescribing in a hospital context.…”

Section: Introductionmentioning

confidence: 99%

“…Previous work packages involved establishing a core outcome set (COS) for hospital deprescribing trials 12 and co-designing the CHARMER intervention. 11 Work Package three will test the feasibility and acceptability of delivering and evaluating the intervention in hospitals in England. This will inform refinements to the intervention and trial processes for the definitive trial to evaluate the effectiveness and cost-effectiveness of CHARMER.…”

Section: Introductionmentioning

confidence: 99%

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CompreHensive geriAtRician-led MEdication Review (CHARMER): protocol for a feasibility study of a hospital deprescribing behaviour change intervention

et al. 2023

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IntroductionOver 50% of older adults are prescribed a medicine where the risk of harm outweighs the chances of benefit. During a hospital admission, older adults and carers expect medicines to be reviewed for appropriateness and any inappropriate medicines proactively deprescribed. While the principle of proactive deprescribing is an expectation of good prescribing practice, it is yet to become routine. The CompreHensive geriAtRician-led MEdication Review (CHARMER) study aims to develop and test a five-component behaviour change intervention to equip geriatricians and pharmacists to proactively deprescribe inappropriate medicines with older adults in hospital. This study aims to test the feasibility and acceptability of study processes and CHARMER implementation.Methods and analysisA two-arm purposive allocation feasibility study is being undertaken at four acute hospitals in England, UK (three intervention and one control). The target sample is 400 patients across all hospitals. Primary outcome measures are: (1) participant recruitment rate and (2) participant attrition rate. Secondary outcome measures are: (1) hospital readmission rate; (2) mortality rate and (3) quality of life. Quantitative data will be checked for completeness and quality, and practitioner and patient demographics descriptively analysed. We will undertake a rapid qualitative analysis on observations, interviews and study meeting minutes data. A subsequent thematic analysis will be undertaken with codes mapped to the Theoretical Domains Framework and Normalisation Process Theory. Triangulation of qualitative and quantitative data will be undertaken.Ethics and disseminationEthics approval was obtained from Wales Research Ethics Committee 1 (IRAS ID 312494) and study approval from the Health Research Authority (22/WA/0087). Informed consent will be sought from all hospital staff involved in data collection activities and for patients involved in enhanced data collection activities. The findings of this study will be disseminated in peer-reviewed journals and conference presentations.Trial registrationISRCTN11899506.

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Development of a Behavior-Change Intervention toward Benzodiazepine Deprescribing in Older Adults Living in Nursing Homes

Evrard,

Henrard,

Spinewine

2024

Journal of the American Medical Directors Association

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Co-design of a behaviour change intervention to equip geriatricians and pharmacists to proactively deprescribe medicines that are no longer needed or are risky to continue in hospital

Cited by 5 publications

References 40 publications

What is known about the determinants of developing antipsychotic-induced metabolic syndrome and interventions to address them for community dwelling adults: a scoping review protocol

What is known about the determinants of developing antipsychotic-induced metabolic syndrome and interventions to address them for community dwelling adults: a scoping review protocol

CompreHensive geriAtRician-led MEdication Review (CHARMER): protocol for a feasibility study of a hospital deprescribing behaviour change intervention

Development of a Behavior-Change Intervention toward Benzodiazepine Deprescribing in Older Adults Living in Nursing Homes

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