The Care Home Independent Prescribing Pharmacist Study (CHIPPS)

A non-randomised feasibility study of independent pharmacist prescribing in care homes

Jacqueline Inch, Frances Notman, Christine Bond (Corresponding Author), David P. Alldred, Antony Arthur, Annie Blyth, Amrit Daffu-O'Reilly, Joanna Ford, Carmel M. Hughes, Vivienne Maskrey, Anna Millar, Phyo K. Myint, Fiona M. Poland, Lee Shepstone, Arnold Zermansky, Richard Holland, David Wright, the CHIPPS Team

Research output: Contribution to journalArticle

Abstract

Background
Residents in care homes are often very frail, have complex medicine regimens and are at high risk of adverse drug events. It has been recommended that one healthcare professional should assume responsibility for their medicines management. We propose that this could be a pharmacist independent prescriber (PIP). This feasibility study aimed to test and refine the service specification and proposed study processes to inform the design and outcome measures of a definitive randomised controlled trial to examine the clinical and cost effectiveness of PIPs working in care homes compared to usual care. Specific objectives included testing processes for participant identification, recruitment and consent and assessing retention rates; determining suitability of outcome measures and data collection processes from care homes and GP practices to inform selection of a primary outcome measure; assessing service and research acceptability; and testing and refining the service specification.

Methods
Mixed methods (routine data, questionnaires and focus groups/interviews) were used in this non-randomised open feasibility study of a 3-month PIP intervention in care homes for older people. Data were collected at baseline and 3 months. One PIP, trained in service delivery, one GP practice and up to three care homes were recruited at each of four UK locations. For ten eligible residents (≥ 65 years, on at least one regular medication) in each home, the PIP undertook management of medicines, repeat prescription authorisation, referral to other healthcare professionals and staff training. Outcomes (falls, medications, resident’s quality of life and activities of daily living, mental state and adverse events) were described at baseline and follow-up and assessed for inclusion in the main study. Participants’ views post-intervention were captured in audio-recorded focus groups and semi-structured interviews. Transcripts were thematically analysed.

Results
Across the four locations, 44 GP practices and 16 PIPs expressed interest in taking part; all care homes invited agreed to take part. Two thirds of residents approached consented to participate (53/86). Forty residents were recruited (mean age 84 years; 61% (24) were female), and 38 participants remained at 3 months (two died). All GP practices, PIPs and care homes were retained. The number of falls per participating resident was selected as the primary outcome, following assessment of the different outcome measures against predetermined criteria. The chosen secondary outcomes/outcome measures include total falls, drug burden index (DBI), hospitalisations, mortality, activities of daily living (Barthel (proxy)) and quality of life (ED-5Q-5 L (face-to-face and proxy)) and selected items from the STOPP/START guidance that could be assessed without need for clinical judgement. No adverse drug events were reported. The PIP service was generally well received by the majority of stakeholders (care home staff, GPS, residents, relatives and other health care professionals). PIPs reported feeling more confident implementing change following the training but reported challenges accommodating the new service within their existing workload.

Conclusion
Implementing a PIP service in care homes is feasible and acceptable to care home residents, staff and clinicians. Findings have informed refinements to the service specification, PIP training, recruitment to the future RCT and the choice of outcomes and outcome measures. The full RCT with internal pilot started in February 2016 and results are expected to be available in mid late 2020.
Original languageEnglish
Article number89
Number of pages14
JournalPilot & Feasibility Studies
Volume5
DOIs
Publication statusPublished - 11 Jul 2019

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Feasibility Studies
Home Care Services
Pharmacists
Outcome Assessment (Health Care)
Proxy
Activities of Daily Living
Drug-Related Side Effects and Adverse Reactions
Focus Groups
Delivery of Health Care
Quality of Life
Interviews
Workload
Cost-Benefit Analysis
Prescriptions
Emotions
Hospitalization
Referral and Consultation
Randomized Controlled Trials
Medicine
Mortality

Cite this

The Care Home Independent Prescribing Pharmacist Study (CHIPPS) : A non-randomised feasibility study of independent pharmacist prescribing in care homes. / Inch, Jacqueline; Notman, Frances; Bond, Christine (Corresponding Author); Alldred, David P.; Arthur, Antony; Blyth, Annie; Daffu-O'Reilly, Amrit ; Ford, Joanna; Hughes, Carmel M.; Maskrey, Vivienne; Millar, Anna ; Myint, Phyo K.; Poland, Fiona M.; Shepstone, Lee; Zermansky, Arnold; Holland, Richard; Wright, David ; the CHIPPS Team.

In: Pilot & Feasibility Studies, Vol. 5, 89, 11.07.2019.

Research output: Contribution to journalArticle

Inch, J, Notman, F, Bond, C, Alldred, DP, Arthur, A, Blyth, A, Daffu-O'Reilly, A, Ford, J, Hughes, CM, Maskrey, V, Millar, A, Myint, PK, Poland, FM, Shepstone, L, Zermansky, A, Holland, R, Wright, D & the CHIPPS Team 2019, 'The Care Home Independent Prescribing Pharmacist Study (CHIPPS): A non-randomised feasibility study of independent pharmacist prescribing in care homes', Pilot & Feasibility Studies, vol. 5, 89. https://doi.org/10.1186/s40814-019-0465-y
Inch, Jacqueline ; Notman, Frances ; Bond, Christine ; Alldred, David P. ; Arthur, Antony ; Blyth, Annie ; Daffu-O'Reilly, Amrit ; Ford, Joanna ; Hughes, Carmel M. ; Maskrey, Vivienne ; Millar, Anna ; Myint, Phyo K. ; Poland, Fiona M. ; Shepstone, Lee ; Zermansky, Arnold ; Holland, Richard ; Wright, David ; the CHIPPS Team. / The Care Home Independent Prescribing Pharmacist Study (CHIPPS) : A non-randomised feasibility study of independent pharmacist prescribing in care homes. In: Pilot & Feasibility Studies. 2019 ; Vol. 5.
@article{532c890363be4a74bd694e2689ae1219,
title = "The Care Home Independent Prescribing Pharmacist Study (CHIPPS): A non-randomised feasibility study of independent pharmacist prescribing in care homes",
abstract = "BackgroundResidents in care homes are often very frail, have complex medicine regimens and are at high risk of adverse drug events. It has been recommended that one healthcare professional should assume responsibility for their medicines management. We propose that this could be a pharmacist independent prescriber (PIP). This feasibility study aimed to test and refine the service specification and proposed study processes to inform the design and outcome measures of a definitive randomised controlled trial to examine the clinical and cost effectiveness of PIPs working in care homes compared to usual care. Specific objectives included testing processes for participant identification, recruitment and consent and assessing retention rates; determining suitability of outcome measures and data collection processes from care homes and GP practices to inform selection of a primary outcome measure; assessing service and research acceptability; and testing and refining the service specification.MethodsMixed methods (routine data, questionnaires and focus groups/interviews) were used in this non-randomised open feasibility study of a 3-month PIP intervention in care homes for older people. Data were collected at baseline and 3 months. One PIP, trained in service delivery, one GP practice and up to three care homes were recruited at each of four UK locations. For ten eligible residents (≥ 65 years, on at least one regular medication) in each home, the PIP undertook management of medicines, repeat prescription authorisation, referral to other healthcare professionals and staff training. Outcomes (falls, medications, resident’s quality of life and activities of daily living, mental state and adverse events) were described at baseline and follow-up and assessed for inclusion in the main study. Participants’ views post-intervention were captured in audio-recorded focus groups and semi-structured interviews. Transcripts were thematically analysed.ResultsAcross the four locations, 44 GP practices and 16 PIPs expressed interest in taking part; all care homes invited agreed to take part. Two thirds of residents approached consented to participate (53/86). Forty residents were recruited (mean age 84 years; 61{\%} (24) were female), and 38 participants remained at 3 months (two died). All GP practices, PIPs and care homes were retained. The number of falls per participating resident was selected as the primary outcome, following assessment of the different outcome measures against predetermined criteria. The chosen secondary outcomes/outcome measures include total falls, drug burden index (DBI), hospitalisations, mortality, activities of daily living (Barthel (proxy)) and quality of life (ED-5Q-5 L (face-to-face and proxy)) and selected items from the STOPP/START guidance that could be assessed without need for clinical judgement. No adverse drug events were reported. The PIP service was generally well received by the majority of stakeholders (care home staff, GPS, residents, relatives and other health care professionals). PIPs reported feeling more confident implementing change following the training but reported challenges accommodating the new service within their existing workload.ConclusionImplementing a PIP service in care homes is feasible and acceptable to care home residents, staff and clinicians. Findings have informed refinements to the service specification, PIP training, recruitment to the future RCT and the choice of outcomes and outcome measures. The full RCT with internal pilot started in February 2016 and results are expected to be available in mid late 2020.",
author = "Jacqueline Inch and Frances Notman and Christine Bond and Alldred, {David P.} and Antony Arthur and Annie Blyth and Amrit Daffu-O'Reilly and Joanna Ford and Hughes, {Carmel M.} and Vivienne Maskrey and Anna Millar and Myint, {Phyo K.} and Poland, {Fiona M.} and Lee Shepstone and Arnold Zermansky and Richard Holland and David Wright and {the CHIPPS Team}",
note = "Acknowledgements We also thank Lisa Irvine who contributed to data analysis. We thank PPIRes (Public and Patient Involvement in Research) for being formal collaborators on the grant and for advice on ongoing conduct of the study as represented by Kate Massey (sadly deceased) and Christine Handford. We thank Helen Hill who is a grant holder with Care Home background and who advised on ongoing conduct of the study, and Ian Small, the lead primary care medicines management pharmacist in Norwich (now retired) and a co-applicant on the NIHR programme grant. On behalf of the CHIPPS Team, we would also like to acknowledge Antony Colles, Norwich Clinical Trials Unit, Norwich Medical School, Faculty of Medicine and Health Sciences and the NHS South Norfolk Clinical Commissioning Group (CCG) as the study sponsor and host of PPIRes, and especially Clare Symms, Norfolk & Suffolk Primary and Community Care Research Office, for her contribution towards the study. Finally, we wish to thank all the participants in this study from general practices and care homes. Registration information The trial was registered on the ISRCTN registry, registration number ISRCTN10663852. The study was overseen by a Programme Management Group (all grant holders, researchers, CTU representatives) and advised by an independent Trial Steering Committee. The protocol is available from the authors on request. Funding This paper reports independent research funded by the National Institute for Health Research (Programme Grants for Applied Research, Care Homes Independent Pharmacist Prescribing Service (CHIPPS): Development and delivery of a cluster randomised controlled trial to determine both its effectiveness and cost-effectiveness, RP-PG-0613-20007). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.",
year = "2019",
month = "7",
day = "11",
doi = "10.1186/s40814-019-0465-y",
language = "English",
volume = "5",
journal = "Pilot & Feasibility Studies",
issn = "2055-5784",
publisher = "BioMed Central",

}

TY - JOUR

T1 - The Care Home Independent Prescribing Pharmacist Study (CHIPPS)

T2 - A non-randomised feasibility study of independent pharmacist prescribing in care homes

AU - Inch, Jacqueline

AU - Notman, Frances

AU - Bond, Christine

AU - Alldred, David P.

AU - Arthur, Antony

AU - Blyth, Annie

AU - Daffu-O'Reilly, Amrit

AU - Ford, Joanna

AU - Hughes, Carmel M.

AU - Maskrey, Vivienne

AU - Millar, Anna

AU - Myint, Phyo K.

AU - Poland, Fiona M.

AU - Shepstone, Lee

AU - Zermansky, Arnold

AU - Holland, Richard

AU - Wright, David

AU - the CHIPPS Team

N1 - Acknowledgements We also thank Lisa Irvine who contributed to data analysis. We thank PPIRes (Public and Patient Involvement in Research) for being formal collaborators on the grant and for advice on ongoing conduct of the study as represented by Kate Massey (sadly deceased) and Christine Handford. We thank Helen Hill who is a grant holder with Care Home background and who advised on ongoing conduct of the study, and Ian Small, the lead primary care medicines management pharmacist in Norwich (now retired) and a co-applicant on the NIHR programme grant. On behalf of the CHIPPS Team, we would also like to acknowledge Antony Colles, Norwich Clinical Trials Unit, Norwich Medical School, Faculty of Medicine and Health Sciences and the NHS South Norfolk Clinical Commissioning Group (CCG) as the study sponsor and host of PPIRes, and especially Clare Symms, Norfolk & Suffolk Primary and Community Care Research Office, for her contribution towards the study. Finally, we wish to thank all the participants in this study from general practices and care homes. Registration information The trial was registered on the ISRCTN registry, registration number ISRCTN10663852. The study was overseen by a Programme Management Group (all grant holders, researchers, CTU representatives) and advised by an independent Trial Steering Committee. The protocol is available from the authors on request. Funding This paper reports independent research funded by the National Institute for Health Research (Programme Grants for Applied Research, Care Homes Independent Pharmacist Prescribing Service (CHIPPS): Development and delivery of a cluster randomised controlled trial to determine both its effectiveness and cost-effectiveness, RP-PG-0613-20007). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

PY - 2019/7/11

Y1 - 2019/7/11

N2 - BackgroundResidents in care homes are often very frail, have complex medicine regimens and are at high risk of adverse drug events. It has been recommended that one healthcare professional should assume responsibility for their medicines management. We propose that this could be a pharmacist independent prescriber (PIP). This feasibility study aimed to test and refine the service specification and proposed study processes to inform the design and outcome measures of a definitive randomised controlled trial to examine the clinical and cost effectiveness of PIPs working in care homes compared to usual care. Specific objectives included testing processes for participant identification, recruitment and consent and assessing retention rates; determining suitability of outcome measures and data collection processes from care homes and GP practices to inform selection of a primary outcome measure; assessing service and research acceptability; and testing and refining the service specification.MethodsMixed methods (routine data, questionnaires and focus groups/interviews) were used in this non-randomised open feasibility study of a 3-month PIP intervention in care homes for older people. Data were collected at baseline and 3 months. One PIP, trained in service delivery, one GP practice and up to three care homes were recruited at each of four UK locations. For ten eligible residents (≥ 65 years, on at least one regular medication) in each home, the PIP undertook management of medicines, repeat prescription authorisation, referral to other healthcare professionals and staff training. Outcomes (falls, medications, resident’s quality of life and activities of daily living, mental state and adverse events) were described at baseline and follow-up and assessed for inclusion in the main study. Participants’ views post-intervention were captured in audio-recorded focus groups and semi-structured interviews. Transcripts were thematically analysed.ResultsAcross the four locations, 44 GP practices and 16 PIPs expressed interest in taking part; all care homes invited agreed to take part. Two thirds of residents approached consented to participate (53/86). Forty residents were recruited (mean age 84 years; 61% (24) were female), and 38 participants remained at 3 months (two died). All GP practices, PIPs and care homes were retained. The number of falls per participating resident was selected as the primary outcome, following assessment of the different outcome measures against predetermined criteria. The chosen secondary outcomes/outcome measures include total falls, drug burden index (DBI), hospitalisations, mortality, activities of daily living (Barthel (proxy)) and quality of life (ED-5Q-5 L (face-to-face and proxy)) and selected items from the STOPP/START guidance that could be assessed without need for clinical judgement. No adverse drug events were reported. The PIP service was generally well received by the majority of stakeholders (care home staff, GPS, residents, relatives and other health care professionals). PIPs reported feeling more confident implementing change following the training but reported challenges accommodating the new service within their existing workload.ConclusionImplementing a PIP service in care homes is feasible and acceptable to care home residents, staff and clinicians. Findings have informed refinements to the service specification, PIP training, recruitment to the future RCT and the choice of outcomes and outcome measures. The full RCT with internal pilot started in February 2016 and results are expected to be available in mid late 2020.

AB - BackgroundResidents in care homes are often very frail, have complex medicine regimens and are at high risk of adverse drug events. It has been recommended that one healthcare professional should assume responsibility for their medicines management. We propose that this could be a pharmacist independent prescriber (PIP). This feasibility study aimed to test and refine the service specification and proposed study processes to inform the design and outcome measures of a definitive randomised controlled trial to examine the clinical and cost effectiveness of PIPs working in care homes compared to usual care. Specific objectives included testing processes for participant identification, recruitment and consent and assessing retention rates; determining suitability of outcome measures and data collection processes from care homes and GP practices to inform selection of a primary outcome measure; assessing service and research acceptability; and testing and refining the service specification.MethodsMixed methods (routine data, questionnaires and focus groups/interviews) were used in this non-randomised open feasibility study of a 3-month PIP intervention in care homes for older people. Data were collected at baseline and 3 months. One PIP, trained in service delivery, one GP practice and up to three care homes were recruited at each of four UK locations. For ten eligible residents (≥ 65 years, on at least one regular medication) in each home, the PIP undertook management of medicines, repeat prescription authorisation, referral to other healthcare professionals and staff training. Outcomes (falls, medications, resident’s quality of life and activities of daily living, mental state and adverse events) were described at baseline and follow-up and assessed for inclusion in the main study. Participants’ views post-intervention were captured in audio-recorded focus groups and semi-structured interviews. Transcripts were thematically analysed.ResultsAcross the four locations, 44 GP practices and 16 PIPs expressed interest in taking part; all care homes invited agreed to take part. Two thirds of residents approached consented to participate (53/86). Forty residents were recruited (mean age 84 years; 61% (24) were female), and 38 participants remained at 3 months (two died). All GP practices, PIPs and care homes were retained. The number of falls per participating resident was selected as the primary outcome, following assessment of the different outcome measures against predetermined criteria. The chosen secondary outcomes/outcome measures include total falls, drug burden index (DBI), hospitalisations, mortality, activities of daily living (Barthel (proxy)) and quality of life (ED-5Q-5 L (face-to-face and proxy)) and selected items from the STOPP/START guidance that could be assessed without need for clinical judgement. No adverse drug events were reported. The PIP service was generally well received by the majority of stakeholders (care home staff, GPS, residents, relatives and other health care professionals). PIPs reported feeling more confident implementing change following the training but reported challenges accommodating the new service within their existing workload.ConclusionImplementing a PIP service in care homes is feasible and acceptable to care home residents, staff and clinicians. Findings have informed refinements to the service specification, PIP training, recruitment to the future RCT and the choice of outcomes and outcome measures. The full RCT with internal pilot started in February 2016 and results are expected to be available in mid late 2020.

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DO - 10.1186/s40814-019-0465-y

M3 - Article

VL - 5

JO - Pilot & Feasibility Studies

JF - Pilot & Feasibility Studies

SN - 2055-5784

M1 - 89

ER -