Assessing deprescribing tools for implementation in care homes: A qualitative study of the views of care home staff

Krystal Warmoth; Jessica Rees; Jo Day; Emma Cockcroft; Alex Aylward; Lucy Pollock; George Coxon; Trudy Craig; Bridget Walton; Ken Stein

doi:10.1016/j.sapharm.2023.11.008

Assessing deprescribing tools for implementation in care homes: A qualitative study of the views of care home staff

Krystal Warmoth, Jessica Rees, Jo Day, Emma Cockcroft, Alex Aylward, Lucy Pollock, George Coxon, Trudy Craig, Bridget Walton, Ken Stein

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Pages (from-to)	1-10
Number of pages	10
Journal	Research in Social and Administrative Pharmacy
Volume	20
Issue number	4
Early online date	16 Dec 2023
DOIs	https://doi.org/10.1016/j.sapharm.2023.11.008
Publication status	E-pub ahead of print - 16 Dec 2023

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Warmoth, K., Rees, J., Day, J., Cockcroft, E., Aylward, A., Pollock, L., Coxon, G., Craig, T., Walton, B., & Stein, K. (2023). Assessing deprescribing tools for implementation in care homes: A qualitative study of the views of care home staff. Research in Social and Administrative Pharmacy, 20(4), 1-10. Advance online publication. https://doi.org/10.1016/j.sapharm.2023.11.008

@article{8b29c0fedfef4de99a59fb1f9e266687,

title = "Assessing deprescribing tools for implementation in care homes: A qualitative study of the views of care home staff",

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.",

author = "Krystal Warmoth and Jessica Rees and Jo Day and Emma Cockcroft and Alex Aylward and Lucy Pollock and George Coxon and Trudy Craig and Bridget Walton and Ken Stein",

note = "{\textcopyright} 2023 Published by Elsevier Inc. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1016/j.sapharm.2023.11.008",

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T1 - Assessing deprescribing tools for implementation in care homes: A qualitative study of the views of care home staff

AU - Warmoth, Krystal

AU - Rees, Jessica

AU - Day, Jo

AU - Cockcroft, Emma

AU - Aylward, Alex

AU - Pollock, Lucy

AU - Coxon, George

AU - Craig, Trudy

AU - Walton, Bridget

AU - Stein, Ken

PY - 2023/12/16

Y1 - 2023/12/16

N2 - 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.

AB - 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.

U2 - 10.1016/j.sapharm.2023.11.008

DO - 10.1016/j.sapharm.2023.11.008

M3 - Article

C2 - 38245383

SN - 1551-7411

VL - 20

SP - 1

EP - 10

JO - Research in Social and Administrative Pharmacy

JF - Research in Social and Administrative Pharmacy

IS - 4

ER -

Assessing deprescribing tools for implementation in care homes: A qualitative study of the views of care home staff

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