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Published on: August 1, 2019

Implementation of a hospital deprescribing behaviour change intervention, the CompreHensive geriAtRician-led

Jacqueline M Martin-Kerry1, Debi Bhattacharya2, Johanna Taylor3

  • 1School of Health Sciences, University of East Anglia, Norwich, UK jackie.martin-kerry@uea.ac.uk.

BMJ Open
|June 2, 2026
PubMed

Insights

This study evaluated the CHARMER intervention to increase proactive deprescribing in hospitals. The CHARMER trial used a stepped-wedge design to assess its effectiveness and cost-effectiveness in improving medication management.

Area of Science:

  • Geriatric Medicine
  • Pharmacology
  • Health Services Research

Background:

  • Proactive deprescribing involves four steps: identifying, evaluating, stopping, and monitoring medication cessation.
  • The CHARMER (CompreHensive geriAtRician-led MEdication Review) trial is a stepped-wedge study assessing a behavior change intervention for proactive deprescribing in hospitals.
  • The CHARMER intervention includes an action plan, briefings, case studies, videos, and a performance dashboard to facilitate deprescribing.

Purpose of the Study:

  • To evaluate the effectiveness and cost-effectiveness of the CHARMER intervention in increasing proactive deprescribing.
  • To explore the implementation processes, behavioral mechanisms, and contextual factors influencing the CHARMER intervention through a process evaluation.

Main Methods:

  • A convergent parallel design process evaluation guided by UK Medical Research Council standards.
  • Interviews with healthcare staff, patients/carers, and primary care practitioners, supplemented by implementation activity recordings and manuals.
  • Quantitative data from questionnaires on deprescribing steps and behavioral mechanisms, analyzed descriptively and with Mann-Whitney tests; qualitative data thematically analyzed and mapped to Normalization Process Theory and Theoretical Domains Framework.

Main Results:

  • The study is designed to capture the extent to which the four proactive deprescribing steps are enacted.
  • It aims to measure the behavioral mechanisms driving the CHARMER intervention's effects.
  • Patient experiences with proactive deprescribing will be assessed.

Conclusions:

  • The CHARMER trial aims to provide evidence on the effectiveness and cost-effectiveness of a comprehensive deprescribing intervention.
  • The process evaluation will offer insights into successful implementation strategies and barriers.
  • Findings will inform future deprescribing initiatives in hospital settings.
Abstract

Keywords:
BehaviorGERIATRIC MEDICINEHospitalsPharmacistsPhysiciansPolypharmacy

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