Co‐designing an intervention to improve the process of deprescribing for older people living with frailty in the United Kingdom

Abstract

Background: In older people living with frailty, polypharmacy can lead to preventable harm like adverse drug reactions and hospitalization. Deprescribing is a strategy to reduce problematic polypharmacy. All stakeholders should be actively involved in developing a person-centred deprescribing process that involves shared decision-making.Objective: To co-design an intervention, supported by a logic model, to increase the engagement of older people living with frailty in the process of deprescribing.Design: Experience-based co-design is an approach to service improvement, which uses service users and providers to identify problems and design solutions. This was used to create a person-centred intervention with the potential to improve the quality and outcomes of the deprescribing process. A 'trigger film' showing older people talking about their healthcare experiences was created and facilitated discussions about current problems in the deprescribing process. Problems were then prioritized and appropriate solutions were developed. The review located the solutions in the context of current processes and procedures. An ideal care pathway and a complex intervention to deliver better care were developed.

A qualitative exploration of barriers to efficient and effective Structured Medication Reviews in Primary Care: Findings from the DynAIRx study

“…This included producing resources in a number of different languages including audio recorded resources for patients with visual impairment. (21, 22) Embedded links to resources for HCPs to provide to patients before and/or after an SMR can be one potential way to utilise digital health and empower patients to reduce inequity in access to healthcare.…”

A rapid review of interventions to improve medicine self‐management for older people living at home

“… 79 More interventions are required to support this population to manage polypharmacy, recognize when their symptoms might be deteriorating and avoid unnecessary stressors that can cause further deterioration. 79 , 80 …”

“…Only one intervention was found that specifically targeted older people with frailty. People living with frailty have been found to be particularly vulnerable to the consequences of inappropriate polypharmacy and medicine errors, and interventions can support patient roles in how medicines are managed in this population 79 . More interventions are required to support this population to manage polypharmacy, recognize when their symptoms might be deteriorating and avoid unnecessary stressors that can cause further deterioration 79,80 …”

“…People living with frailty have been found to be particularly vulnerable to the consequences of inappropriate polypharmacy and medicine errors, and interventions can support patient roles in how medicines are managed in this population. 79 More interventions are required to support this population to manage polypharmacy, recognize when their symptoms might be deteriorating and avoid unnecessary stressors that can cause further deterioration. 79,80 Complex medicine regimens, polypharmacy and multimorbidity in older populations have been associated with negative health outcomes.…”

“…79 More interventions are required to support this population to manage polypharmacy, recognize when their symptoms might be deteriorating and avoid unnecessary stressors that can cause further deterioration. 79,80 Complex medicine regimens, polypharmacy and multimorbidity in older populations have been associated with negative health outcomes. 13,16 Conversely, it was surprising to find that only 7…”