Co-development of a Deprescribing Program for Older Community-dwelling Patients Treated With Anticholinergic/Sedative Medications (CC-DIOPAS)

Co-development of a Multidisciplinary, Participatory Deprescribing Program for Older Community-dwelling Patients Treated by Medications With Anticholinergic and/or Sedative Properties

About 20% of emergency room admissions among people over the age of 75 are related to medication-induced adverse events. These events are exacerbated by polypharmacy, which can be inappropriate when prescribed medications have an uncertain benefit-risk balance or cause harmful drug interactions. Among potentially inappropriate medications (PIMs), those with anticholinergic and/or sedative properties are the most harmful to older adults and yet are very frequently prescribed. Indeed, in France, 33% of older patients living at home are treated with this type of medication, the use of which is associated with cognitive decline, falls, functional decline (loss of independence), excess mortality, reduced quality of life, and hospitalizations.

Thus, reducing the burden of anticholinergic and sedative medications in older adults is a key priority in the prevention of iatrogenic risk. Among the strategies developed to reduce the use of PIMs in older patients, deprescribing interventions-defined as the supervised discontinuation of inappropriate treatment-have been gradually implemented in recent years. However, few interventional studies on the deprescribing of anticholinergic and/or sedative medications have demonstrated positive results. To better understand the inconsistent effectiveness of deprescribing programs, studies have been conducted to identify the barriers and facilitators of deprescribing, and three key areas have been identified to facilitate the implementation of such programs:

• Involve and support patients in the co-design of the intervention (participatory research) and throughout the intervention itself to reach a shared decision.
• Work in an interdisciplinary manner by combining the areas of expertise of outpatient healthcare professionals regarding patient knowledge and support with the expertise of hospital-based professionals in the field of aging.
• Work in a coordinated manner to foster interprofessional cooperation and ensure the transferability of the deprescribing pathway in real-world settings through multi-professional consultation.

The DIOPAS project aims to develop and implement a multidisciplinary, participatory deprescribing program for older community-dwelling patients being treated by medications with anticholinergic and/or sedative properties. The first step involves the co-development of the intervention, which is the focus of this CC-DIOPAS study. This study proposes a participatory co-development approach to the intervention, bringing together the various types of professionals (from both primary care and hospital) involved in medication optimization, as well as community-dwelling patients and patient partners.

Study Overview

• Status: Completed
• Conditions: Deprescribing
• Intervention / Treatment: Behavioral: Focus groups and workshops of healthcare professionals and patients

• Study Type: Observational
• Enrollment (Actual): 35

Contacts and Locations

Study Locations

• France
  • Villeurbanne, France, 69100
    • Hôpital des Charpennes, Institut du Vieillissement

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

• Hospital healthcare professionals involved in geriatric outpatient care and in the medication management of older patients: geriatricians, hospital pharmacists, and nurses
• Primary care healthcare professionals involved in the medication management of the target population: general practitioners, community pharmacists, and private practice nurses
• Patients who met the study's eligibility criteria regarding age and polypharmacy so that the co-designed intervention takes into account their needs and expectations, as well as their opinions regarding the methodology used (participative research). Partner patients will also be solicited.

Description

Inclusion Criteria:

• Healthcare Professionals:

In hospitals:

• Geriatricians, hospital pharmacists, or registered nurses;
• Practicing in a geriatric day hospital at the university hospitals in Lyon, Grenoble, Marseille, Nîmes, or Nantes;
• Agree to participate in focus group meetings or the working group.

In primary care facilities:

• General practitioners, community pharmacists, or independent registered nurses;
• Practicing within a primary care facility in the geographic areas served by the university hospitals of Lyon, Grenoble, Marseille, Nîmes, or Nantes;
• Agree to participate in focus group meetings or the working group.

Patients:

Patients of the primary care facilities :

• Patients aged 65 to 80;
• Patients receiving outpatient care (not hospitalized) at a primary care facility within the geographic areas of the University Hospitals of Lyon;
• Patients taking at least 5 chronic medications prescribed per day (polypharmacy);
• Agree to participate in focus group meetings or the working group;

Partner patients:

• Partner patients of the Lyon University Hospital or the RESHAPE laboratory;
• Agree to participate in meetings of the working group or the study's scientific advisory board.

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Healthcare professionals and patients; Health professionals and patients will be asked during focus groups and workshop on the co-developed deprescribing program

Behavioral: Focus groups and workshops of healthcare professionals and patients; This is a qualitative study conducted in two successive phases. First, three focus groups comprising patients and healthcare professionals from both hospital and primary care settings will assess their needs, expectations, and initiatives regarding support for deprescribing, and identify the barriers and facilitators to implement a multidisciplinary pathway. In a second phase, a multidisciplinary working group will be tasked with developing a logic model for deprescribing. This group will include hospital-based healthcare professionals, primary care professionals, and patients, with the aim of designing an intervention that is both implementable and transferable to real-world settings (2-5 workshops).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Logic model for the deprescribing pathway	Logic model for the community-to-hospital deprescribing pathway (DIOPAS intervention), developed by the mixed working group.	Through study completion, an average of 6 months (Following the last working group meeting)

Collaborators and Investigators

• Sponsor: Hospices Civils de Lyon

Study record dates

Study Major Dates

• Study Start (Actual): April 28, 2025
• Primary Completion (Actual): November 27, 2025
• Study Completion (Actual): January 16, 2026

Study Registration Dates

• First Submitted: June 2, 2026
• First Submitted That Met QC Criteria: June 25, 2026
• First Posted (Actual): June 26, 2026

Study Record Updates

• Last Update Posted (Actual): June 26, 2026
• Last Update Submitted That Met QC Criteria: June 25, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Qualitative study; Deprescribing; Potentialy inapropriate medication; Participative research; Intervention co-development
• Additional Relevant MeSH Terms: Health Care Quality, Access, and Evaluation; Investigative Techniques; Epidemiologic Methods; Data Collection; Health Care Evaluation Mechanisms; Quality of Health Care; Public Health; Environment and Public Health; Focus Groups
• Other Study ID Numbers: 24-5457

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No