Abstract
The English National Overprescribing Review identified that older people often take eight or more medicines a day. The report recommended pharmacists in primary care should take responsibility for addressing polypharmacy. Overprescribing is a safety concern in care homes as approximately half of
older care home residents are prescribed at least one medicine that is unnecessary or now harmful. This predisposes them to adverse outcomes including hospitalisation and mortality. Deprescribing is the planned activity of stopping or reducing a medicine that may no longer be appropriate.
Deprescribing, when performed by a pharmacist, is a multidisciplinary activity requiring close communication with general practitioners (GPs) and care home staff. A recently completed trial that integrated pharmacists with prescribing rights into older peoples’ care homes found significant variation in proactive deprescribing activity. The aim of the current study was to specifically explore
beliefs and practices of deprescribing in care homes. A qualitative approach was adopted to examine individual, social and contextual factors that acted as enablers and barriers to pharmacist deprescribing in care homes. Semi-structured interviews were conducted with participants of the previous study (16 pharmacists, six GPs, seven care home staff from Northern Ireland, Scotland and
England). Using thematic analysis, we identified two themes: 1) Structures and systems affecting deprescribing, i.e. the context in which deprescribing happened, including team involvement and routine practices in GP surgeries and care homes; 2) Balancing risks when deprescribing, i.e. the perception of individual risk and social barriers were mitigated by understanding the medical
background of residents. This supported clinical understanding that risks from overprescribing were greater than risks from deprescribing. While deprescribing can involve all health professionals in the primary care team, these results suggest the pharmacist is well placed to lead the process; by having both clinical competence and professional willingness to drive this activity forward.
older care home residents are prescribed at least one medicine that is unnecessary or now harmful. This predisposes them to adverse outcomes including hospitalisation and mortality. Deprescribing is the planned activity of stopping or reducing a medicine that may no longer be appropriate.
Deprescribing, when performed by a pharmacist, is a multidisciplinary activity requiring close communication with general practitioners (GPs) and care home staff. A recently completed trial that integrated pharmacists with prescribing rights into older peoples’ care homes found significant variation in proactive deprescribing activity. The aim of the current study was to specifically explore
beliefs and practices of deprescribing in care homes. A qualitative approach was adopted to examine individual, social and contextual factors that acted as enablers and barriers to pharmacist deprescribing in care homes. Semi-structured interviews were conducted with participants of the previous study (16 pharmacists, six GPs, seven care home staff from Northern Ireland, Scotland and
England). Using thematic analysis, we identified two themes: 1) Structures and systems affecting deprescribing, i.e. the context in which deprescribing happened, including team involvement and routine practices in GP surgeries and care homes; 2) Balancing risks when deprescribing, i.e. the perception of individual risk and social barriers were mitigated by understanding the medical
background of residents. This supported clinical understanding that risks from overprescribing were greater than risks from deprescribing. While deprescribing can involve all health professionals in the primary care team, these results suggest the pharmacist is well placed to lead the process; by having both clinical competence and professional willingness to drive this activity forward.
| Original language | English |
|---|---|
| Pages (from-to) | e6521-e6531 |
| Number of pages | 11 |
| Journal | Health & Social Care in the Community |
| Volume | 30 |
| Issue number | 6 |
| Early online date | 6 Nov 2022 |
| DOIs | |
| Publication status | Published - 6 Nov 2022 |
Bibliographical note
Funding statement This research is funded by the National Institute for Health Research (NIHR) Policy Research Programme (project reference NIHR202053). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.Acknowledgements Thank you to the pharmacists, GP practice and care home staff who took part in the interviews. We would also like to acknowledge the Norfolk and Waveney Clinical Commissioning Group as the study sponsor and our patient and public involvement colleagues Janet Gray and Christine Hanford who were supported by Jacqueline Romero, manager of PPIRes.
Keywords
- primary care
- over prescribing
- Medicines management
- older people
- deprescribing
- GP
- Care home staff
- pharmacist