A feasibility study of a theory-based intervention to improve appropriate polypharmacy for older people in primary care

Cathal A Cadogan, Cristín Ryan, Gerard J Gormley, Jill J Francis, Peter Passmore, Ngaire Kerse, Carmel M Hughes, Cathal A Cadogan, Cristín Ryan, Gerard J Gormley, Jill J Francis, Peter Passmore, Ngaire Kerse, Carmel M Hughes

Abstract

Background: A general practitioner (GP)-targeted intervention aimed at improving the prescribing of appropriate polypharmacy for older people was previously developed using a systematic, theory-based approach based on the UK Medical Research Council's complex intervention framework. The primary intervention component comprised a video demonstration of a GP prescribing appropriate polypharmacy during a consultation with an older patient. The video was delivered to GPs online and included feedback emphasising the positive outcomes of performing the behaviour. As a complementary intervention component, patients were invited to scheduled medication review consultations with GPs. This study aimed to test the feasibility of the intervention and study procedures (recruitment, data collection).

Methods: GPs from two general practices were given access to the video, and reception staff scheduled consultations with older patients receiving polypharmacy (≥4 medicines). Primary feasibility study outcomes were the usability and acceptability of the intervention to GPs. Feedback was collected from GP and patient participants using structured questionnaires. Clinical data were also extracted from recruited patients' medical records (baseline and 1 month post-consultation). The feasibility of applying validated assessment of prescribing appropriateness (STOPP/START criteria, Medication Appropriateness Index) and medication regimen complexity (Medication Regimen Complexity Index) to these data was investigated. Data analysis was descriptive, providing an overview of participants' feedback and clinical assessment findings.

Results: Four GPs and ten patients were recruited across two practices. The intervention was considered usable and acceptable by GPs. Some reservations were expressed by GPs as to whether the video truly reflected resource and time pressures encountered in the general practice working environment. Patient feedback on the scheduled consultations was positive. Patients welcomed the opportunity to have their medications reviewed. Due to the short time to follow-up and a lack of detailed clinical information in patient records, it was not feasible to detect any prescribing changes or to apply the assessment tools to patients' clinical data.

Conclusion: The findings will help to further refine the intervention and study procedures (including time to follow-up) which will be tested in a randomised pilot study that will inform the design of a definitive trial to evaluate the intervention's effectiveness.

Trial registration: ISRCTN18176245.

Keywords: Behaviour change; Feasibility; General practice; Intervention; Polypharmacy; Prescribing; Theoretical Domains Framework.

Conflict of interest statement

Ethics approval and consent to participate

The ethical approval was granted by the Office of Research Ethics Committees Northern Ireland (REC reference 15/NI/0104). All the participants received information about the study when first invited to participate and provided written informed consent.

Consent for publication

The consent to publish the data collected as part of this project was given by all the participants.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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