STOPPING
Research type
Research Study
Full title
Understanding stakeholders’ perspectives on implementing deprescribing in care homes (STOPPING)
IRAS ID
268492
Contact name
Krystal Warmoth
Contact email
Sponsor organisation
University of Hertfordshire
Duration of Study in the UK
0 years, 11 months, 21 days
Research summary
Summary of Research
People with multiple health problems often take many medicines. However, some medicines may not have benefits for those taking them and cause more harm than good, especially as we get older or more ill. Deprescribing means reducing or stopping prescription medicines which may no longer be providing benefit. Previous research has found that deprescribing is generally safe, but we still don’t really know how to make it work in real life settings, like care homes. Implementing deprescribing in care homes can be challenging due to the different concerns of residents, staff, clinicians, family members, and carers and differences in care home structures. We aim to study how deprescribing can be best implemented in care homes, considering different views and environments.
Research Aims
The overall aim of the study is to develop an approach to deprescribing that works in practice, outside of a research setting. We will:
1. Identify what helps and what hinders deprescribing in two different types of care home providers (independently owned small business and part of a larger not-for-profit organisation);
2. Identify whether current deprescribing approaches are acceptable, practicable and suitable;
3. Create guidance for developing a new way of deprescribing for care homes.Design and Methods
We will use different research methods for this study: (1) interviews with residents and their family members/friends about their experiences, (2) focus groups with staff and healthcare professionals at two care homes about their experiences, (3) interviews with care home staff and healthcare professionals about current deprescribing approaches, and (4) observations at care homes. We will combine the findings with the help of an established method to produce an early version of a deprescribing approach which is suitable for care homes.Dissemination
We will work with residents, carers, and clinicians to co-create targeted plain language summaries and make these available to care home residents and staff, pharmacists, general practitioners, nurses, other health professionals, carers, researchers, and the public. We will feed back the results of our research to those that took part. We will also prepare papers for publication in academic journals, with patient and public representatives as co-authors, if appropriate, and present the findings at scientific conferences.Summary of Final report
People living in care homes often have multiple health problems and take many medicines. However, some medicines may not have benefits for those taking them and potentially cause more harm than good, especially as someone becomes frailer. Deprescribing means reducing or stopping prescription medicines that may no longer be providing benefit. Previous research has found that deprescribing is generally safe in a clinical setting, like a hospital, but we do not know how to make it work well in care homes. Deprescribing in care homes can be difficult due to the different concerns of residents, care home staff, clinicians, and family members and differences in care home organisations. We aimed to generate a list of considerations for designing a deprescribing approach for care homes.
The research had two key parts:
1. We spoke to care home residents, family carers, care home staff and healthcare professionals from different types of care home providers (small independently-owned and a larger organisations) to understand their views and experiences of reducing and/or stopping medicines;
2. We spoke to care home staff about their thoughts on available tools to help with deprescribing to understand if they are appropriate for a care home setting.
The key findings were that deprescribing is a complex and collaborative process. It involved many individuals with different clinical and care skills and beliefs. Current tools and approaches were not suitable for care homes and would need to be changed. The communication and collaboration between care homes and healthcare professionals (e.g., GPs) are essential to ensure deprescribing is done well.
This project helps provide guidance for developing an approach that is suitable and helpful for care homes to support deprescribing safely and effectively. This knowledge will be shared with care home residents and staff, pharmacists, general practitioners, policymakers, researchers, and the public.REC name
Social Care REC
REC reference
19/IEC08/0058
Date of REC Opinion
8 Jan 2020
REC opinion
Further Information Favourable Opinion