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A practitioner behaviour change intervention for deprescribing in the hospital setting
Sion Scott1, Helen May2, Martyn Patel2
1School of Pharmacy, University of East Anglia, Norwich, NR4 7TJ, UK.
Age and Ageing
|September 3, 2020
Summary
Hospital deprescribing interventions need a sixth component focused on sustaining activity to maintain effectiveness. This ensures long-term success beyond trial periods for geriatricians and pharmacists.
Area of Science:
- Geriatric Medicine
- Clinical Pharmacy
- Healthcare Implementation Science
Background:
- Hospital deprescribing trials show limited, unsustainable increases in activity.
- The hospital deprescribing implementation framework (hDIF) outlines 44 intervention components.
- Previous interventions often lack sustained impact beyond trial periods.
Purpose of the Study:
- To guide geriatricians and pharmacists in selecting and characterizing hDIF components.
- To design a sustainable deprescribing intervention for the English hospital setting.
- To evaluate intervention components using the APEASE criteria (affordability, practicability, effectiveness, acceptability, safety, equity).
Main Methods:
- A modified Nominal Group Technique was used with nine geriatricians and pharmacists from five English hospitals.
- Panel members selected and characterized hDIF components based on APEASE criteria.
- An 80% consensus threshold was applied for including intervention components.
Main Results:
- Five components were selected to support initial deprescribing engagement.
- These included an organizational action plan, targeted training for pharmacists, restructured workflows, and patient/family engagement strategies.
- A sixth component focused on measuring and sharing deprescribing activity was chosen to sustain engagement.
Conclusions:
- Deprescribing interventions in English hospitals should incorporate these six components.
- A dedicated component for sustaining deprescribing activity is crucial for long-term efficacy.
- This contrasts with previous interventions that often failed to maintain effectiveness.
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