Understanding stakeholders’ perspectives on implementing deprescribing in care homes (STOPPING)

Background
People with multiple health problems often take many medicines. However, some medicines may not have benefits for those taking them and cause more harm than good, especially as we get older or more ill. Deprescribing means reducing or stopping prescription medicines which may no longer be providing benefit. Previous research has found that deprescribing is generally safe, but we still don’t really know how to make it work in real life settings, like care homes. Implementing deprescribing in care homes can be challenging due to the different concerns of residents, staff, clinicians, family members, and carers and differences in care home structures. We aim to study how deprescribing can be best implemented in care homes, considering different views and environments.
Research Aims
The overall aim of the study is to develop an approach to deprescribing that works in practice, outside of a research setting. We will:
1. Identify what helps and what hinders deprescribing in two different types of care home providers (independently owned small business and part of a larger not-for-profit organisation);
2. Identify whether current deprescribing approaches are acceptable, practicable and suitable;
3. Create guidance for developing a new way of deprescribing for care homes.
Design and Methods
We will use different research methods for this study: (1) interviews with residents and their family members/friends about their experiences, (2) focus groups with staff and healthcare professionals about their experiences, (3) interviews with care home staff and healthcare professionals about current deprescribing approaches, and (4) observations at care homes. We will combine the findings with the help of an established method to produce an early version of a deprescribing approach which is suitable for care homes.
Patient and public involvement
Care home residents, family members, care home staff, and healthcare professionals including general practitioners were involved in the development of this proposal. All acknowledged the challenges with deprescribing and supported the need for this project. One co-applicant is a member of the local Patient Involvement Group and will act as a patient and public involvement representative on the research team. A larger patient advisory group will also meet every 6 months and will be involved in the production of study materials, discussion of preliminary results, interpretation of overall findings and identification of key audiences for dissemination.
Dissemination
We will work with patients, carers, and clinicians to co-create targeted plain language summaries and make these available to care home residents and staff, pharmacists, general practitioners, nurses, other health professionals, carers, researchers, and the public. We will also prepare papers for publication in academic journals, with patient and public representatives as co-authors, if appropriate, and present the findings at scientific conferences.