Safely stopping medicines that are no longer needed. V1
Research type
Research Study
Full title
To undertake a mixed method evaluation of the implementation of a comprehensive deprescribing process model, DEPPLOY, for problematic polypharmacy in frail older adults in general practice.
IRAS ID
297409
Contact name
Jane Dennison
Contact email
Sponsor organisation
Bradford Teaching Hospitals Foundation Trust
Duration of Study in the UK
1 years, 0 months, 0 days
Research summary
Research Summary
Primary Care Networks are mandated by NHS England to undertake Structured Medicine Reviews (SMRs) and one potential outcome is a decision to stop an unnecessary medicine, for example, a medicine where the patient is experiencing side-effects, is no longer needed because the condition has been successfully treated, or the risks outweigh the benefits. This is particularly important for older people living with frailty because they are at high risk of taking medicines which cause adverse events. Based on previous research and co-design with healthcare professionals, patients, and their informal carers, we have developed a bundle of individual elements that are designed to enhance the existing structured medicine review (SMR) service to support older adults with frailty to safely stop unnecessary medicines, collectively termed ‘DEPPLOY’ which stands for ‘DEprescribing for Problematic PoLypharmacy in Older adults with frailty. Each element is outlined below:
- A case finding tool to identify patients who should be prioritised to have their medicines reviewed.
- A patient invite letter that outlines what the patient should expect by attending the consultation.
- A ‘Safely Stopping your Medicines leaflet’ designed to facilitate shared decision making and document the decisions made during the consultation, and outline details of follow-up.
- A patient satisfaction questionnaire to provide routinely collected data on patient satisfaction with the process, and to enable the participating practice to evaluate their structured medicine review programme.
The study outlined will conduct a feasibility study of the pilot implementation of DEPPLOY, including a process evaluation, for the purpose of service enhancement of the existing SMR programme in primary care. Specifically, we aim to implement DEPPLOY in a small sample of GP practices to study its implementation and assess its acceptability to staff and patients. We also aim to identify useful patient outcome measures related to deprescribing for a future full trial of DEPPLOY.Summary of Results
Older people who are living with frailty are more likely to have poor health outcomes because they may become very unwell and less able to recover, even from relatively minor illness. Older people living with frailty often have several health conditions and as a result, may take multiple medicines, known as polypharmacy. Taking too many medicines can cause side-effects which can affect patients’ quality-of-life. Decisions may need to be made to remove, switch or reduce the dose of medicines to better support patient treatment. The process of doing this is called deprescribing.
Consultations called Structured Medication Reviews (SMRs) were introduced by the NHS in primary care in 2021/22. These were introduced so that healthcare professionals and patients could have a shared discussion about the medicines patients were taking, and whether any changes were needed to improve patients’ symptoms and health. Research has shown that both GPs and patients can be apprehensive about stopping or reducing medicines. We designed four tools that could help make stopping or reducing medicines easier and safer. We created a tool which identified patients who would benefit the most from a medication review, an invitation letter to help patients feel more prepared and empowered to discuss their medicines, a safely stopping medicines document which recorded any medicines stopped or changed and could be taken away by the patient, and a feedback questionnaire.These tools were tested in a single GP practice in West Yorkshire. They were used as part of business-as-usual in this busy GP practice and patients took part in medication reviews as they would normally do so. Staff were trained how to use the tools as part of their discussions. We interviewed practice staff involved in the medication reviews to gain their views on the use of these tools and their value. We also interviewed senior practice staff not involved in the medication reviews for their opinion on how these tools should be used. Patients were invited as part of the medication review to complete the feedback questionnaire and then to provide further feedback by interview. Additional anonymised information (this was at practice-level and not patient-level) was also collected from the practice to add to the interview findings.
The findings showed us that patients were very positive about the invitation letter and safely stopping medicines leaflet. They felt more confident and empowered going into the medication review and liked having a tangible record of any medication changes in the leaflet. This was clear in the feedback questionnaires and interviews. Staff really appreciated the tool which identified patients for medication review, as it allowed them to target their efforts to the patients who really needed them, and also the tools offered a structure when stopping medicines. The staff reported that the medication review overall was longer in time and this when scaled up this could cause time pressures for the staff.
We have shared our findings via conferences and a journal article is in the final stages of writing. Some of the tools used in this study have been adopted by the Health Innovation Network, translated into other 11 languages and are now available to use across England.
REC name
Wales REC 3
REC reference
21/WA/0298
Date of REC Opinion
17 Sep 2021
REC opinion
Favourable Opinion