Determinants of implementing deprescribing for older adults in English care homes: a qualitative interview study

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

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Abstract

Objectives To explore the factors that may help or hinder deprescribing practice for older people within care homes.
Design Qualitative semistructured interviews using framework analysis informed by the Consolidated Framework for Implementation Research (CFIR).
Setting Participants were recruited from two care home provider organisations (a smaller independently owned organisation and a large organisation) in England.
Participants A sample of 23 care home staff, 8 residents, 4 family members and 1 general practitioner were associated with 15 care homes.
Results Participants discussed their experiences and perceptions of implementing deprescribing within care homes. Major themes of (1) deprescribing as a complex process and (2) internal and external contextual factors influencing deprescribing practice (such as beliefs, abilities and relationships) were interrelated and spanned several CFIR constructs and domains. The quality of local relationships with and support from healthcare professionals were considered more crucial factors than the type of care home management structure.
Conclusions Several influencing social and contextual factors need to be considered for implementing deprescribing for older adults in care homes. Additional training, tools, support and opportunities need to be made available to care home staff, so they can feel confident and able to question or raise concerns about medicines with prescribers. Further work is warranted to design and adopt a deprescribing approach which addresses these determinants to ensure successful implementation.
Original languageEnglish
Article numbere081305
Pages (from-to)1-11
Number of pages11
JournalBMJ Open
Volume13
Issue number11
Early online date23 Nov 2023
DOIs
Publication statusPublished - 23 Nov 2023

Keywords

  • Humans
  • Aged
  • Nursing Homes
  • Deprescriptions
  • Attitude of Health Personnel
  • Qualitative Research
  • General Practitioners
  • patient-centered care
  • qualitative research
  • health services for the aged
  • implementation science

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