Process evaluation for the Care Homes Independent Pharmacist Prescriber Study (CHIPPS).
Care homes
Deprescribing
Implementation
Older people medication
Pharmacist
Primary care
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
02 Oct 2021
02 Oct 2021
Historique:
received:
16
05
2021
accepted:
04
09
2021
entrez:
3
10
2021
pubmed:
4
10
2021
medline:
6
10
2021
Statut:
epublish
Résumé
Medicines management in care homes requires significant improvement. CHIPPS was a cluster randomised controlled trial to determine the effectiveness of integrating pharmacist independent prescribers into care homes to assume central responsibility for medicines management. This paper reports the parallel mixed-methods process evaluation. Intervention arm consisted of 25 triads: Care homes (staff and up to 24 residents), General Practitioner (GP) and Pharmacist Independent Prescriber (PIP). Data sources were pharmaceutical care plans (PCPs), pharmacist activity logs, online questionnaires and semi-structured interviews. Quantitative data were analysed descriptively. Qualitative data were analysed thematically. Results were mapped to the process evaluation objectives following the Medical Research Council framework. PCPs and activity logs were available from 22 PIPs. Questionnaires were returned by 16 PIPs, eight GPs, and two care home managers. Interviews were completed with 14 PIPs, eight GPs, nine care home managers, six care home staff, and one resident. All stakeholders reported some benefits from PIPs having responsibility for medicine management and identified no safety concerns. PIPs reported an increase in their knowledge and identified the value of having time to engage with care home staff and residents during reviews. The research paperwork was identified as least useful by many PIPs. PIPs conducted medication reviews on residents, recording 566 clinical interventions, many involving deprescribing; 93.8% of changes were sustained at 6 months. For 284 (50.2%) residents a medicine was stopped, and for a quarter of residents, changes involved a medicine linked to increased falls risk. Qualitative data indicated participants noted increased medication safety and improved resident quality of life. Contextual barriers to implementation were apparent in the few triads where PIP was not known previously to the GP and care home before the trial. In three triads, PIPs did not deliver the intervention. The intervention was generally implemented as intended, and well-received by most stakeholders. Whilst there was widespread deprescribing, contextual factors effected opportunity for PIP engagement in care homes. Implementation was most effective when communication pathways between PIP and GP had been previously well-established. The definitive RCT was registered with the ISRCTN registry (registration number ISRCTN 17847169 ).
Sections du résumé
BACKGROUND
BACKGROUND
Medicines management in care homes requires significant improvement. CHIPPS was a cluster randomised controlled trial to determine the effectiveness of integrating pharmacist independent prescribers into care homes to assume central responsibility for medicines management. This paper reports the parallel mixed-methods process evaluation.
METHOD
METHODS
Intervention arm consisted of 25 triads: Care homes (staff and up to 24 residents), General Practitioner (GP) and Pharmacist Independent Prescriber (PIP). Data sources were pharmaceutical care plans (PCPs), pharmacist activity logs, online questionnaires and semi-structured interviews. Quantitative data were analysed descriptively. Qualitative data were analysed thematically. Results were mapped to the process evaluation objectives following the Medical Research Council framework.
RESULTS
RESULTS
PCPs and activity logs were available from 22 PIPs. Questionnaires were returned by 16 PIPs, eight GPs, and two care home managers. Interviews were completed with 14 PIPs, eight GPs, nine care home managers, six care home staff, and one resident. All stakeholders reported some benefits from PIPs having responsibility for medicine management and identified no safety concerns. PIPs reported an increase in their knowledge and identified the value of having time to engage with care home staff and residents during reviews. The research paperwork was identified as least useful by many PIPs. PIPs conducted medication reviews on residents, recording 566 clinical interventions, many involving deprescribing; 93.8% of changes were sustained at 6 months. For 284 (50.2%) residents a medicine was stopped, and for a quarter of residents, changes involved a medicine linked to increased falls risk. Qualitative data indicated participants noted increased medication safety and improved resident quality of life. Contextual barriers to implementation were apparent in the few triads where PIP was not known previously to the GP and care home before the trial. In three triads, PIPs did not deliver the intervention.
CONCLUSIONS
CONCLUSIONS
The intervention was generally implemented as intended, and well-received by most stakeholders. Whilst there was widespread deprescribing, contextual factors effected opportunity for PIP engagement in care homes. Implementation was most effective when communication pathways between PIP and GP had been previously well-established.
TRIAL REGISTRATION
BACKGROUND
The definitive RCT was registered with the ISRCTN registry (registration number ISRCTN 17847169 ).
Identifiants
pubmed: 34600542
doi: 10.1186/s12913-021-07062-3
pii: 10.1186/s12913-021-07062-3
pmc: PMC8487235
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1041Investigateurs
Annie Blyth
(A)
Laura Watts
(L)
Amrit Daffu-O'Reilly
(A)
Informations de copyright
© 2021. The Author(s).
Références
Cochrane Database Syst Rev. 2014 Oct 07;(10):CD008165
pubmed: 25288041
Pharmacy (Basel). 2019 Aug 03;7(3):
pubmed: 31382582
Gastroenterol Res Pract. 2016;2016:1215746
pubmed: 26884751
J Am Med Dir Assoc. 2018 Apr;19(4):371.e11-371.e17
pubmed: 29402652
Drugs Aging. 2009;26(8):677-86
pubmed: 19685933
Int J Geriatr Psychiatry. 2005 Aug;20(8):730-7
pubmed: 16035124
BMJ Glob Health. 2019 Jan 25;4(Suppl 1):e000893
pubmed: 30775016
J Am Med Dir Assoc. 2013 Jul;14(7):471-8
pubmed: 23566932
J Am Med Dir Assoc. 2018 Apr;19(4):372.e1-372.e8
pubmed: 29402646
Cochrane Database Syst Rev. 2016 Feb 12;2:CD009095
pubmed: 26866421
Health Soc Care Community. 2020 Sep;28(5):1479-1487
pubmed: 32124516
BMC Health Serv Res. 2020 Jun 18;20(1):555
pubmed: 32552886
J Clin Pharm Ther. 2019 Aug;44(4):595-602
pubmed: 30793340
Qual Saf Health Care. 2009 Oct;18(5):341-6
pubmed: 19812095
Trials. 2020 May 29;21(1):439
pubmed: 32471514
Int J Pharm Pract. 2021 Aug 11;29(4):376-384
pubmed: 34018561
BMC Health Serv Res. 2011 Nov 24;11:320
pubmed: 22115126
BMC Geriatr. 2019 May 7;19(1):130
pubmed: 31064365
Arch Intern Med. 2007 Apr 23;167(8):781-7
pubmed: 17452540
Eur Geriatr Med. 2020 Dec;11(6):1043-1050
pubmed: 32813154
J Am Med Dir Assoc. 2014 Oct;15(10):706-18
pubmed: 25112229
BMC Geriatr. 2017 Jan 26;17(1):32
pubmed: 28122506
J Am Geriatr Soc. 2020 Dec;68(12):2797-2804
pubmed: 32798337
Trials. 2017 Apr 12;18(1):175
pubmed: 28403876
Res Social Adm Pharm. 2019 Apr;15(4):338-345
pubmed: 29907317
Trials. 2020 Jan 21;21(1):103
pubmed: 31964398
J Am Med Dir Assoc. 2018 Apr;19(4):371.e1-371.e9
pubmed: 29396189
Pilot Feasibility Stud. 2019 Jul 11;5:89
pubmed: 31338204