Developing a Theoretically Informed Strategy to Enhance Pharmacist-Led Deprescribing in Care Homes for Older People.

Abstract

Polypharmacy is prevalent in older people residing in care homes. Deprescribing, reducing or stopping harmful or unnecessary medicines, leads to improvements in patient- and health-system-orientated outcomes. This study identified the barriers and enablers to pharmacists proactively deprescribing in United Kingdon care homes. It draws on methods from behavioural science. Twenty-nine participants who had previously taken part in a deprescribing randomised control trial (sixteen pharmacists, six primary care doctors, and seven care home managers) were interviewed. Data were mapped to the Theoretical Domains Framework to understand pharmacists' deprescribing behaviour. Barriers were deprescribing seen as risky and perceived resistance to deprescribing by residents, their families, and care home staff. Enablers were seeing benefits from deprescribing, part of a pharmacists' role, and endorsement from a doctor. Ways to change pharmacist behaviour were identified from a suite of behaviour change techniques (BCT). Using a modified Nominal Group Technique, 15 staff (six pharmacists, five primary care doctors, and four care home managers) naïve to deprescribing interventions completed an online survey to assess the feasibility and acceptability of implementing the 27 BCTs. Seven BCTs achieved a more that 80% consensus on all implementation criteria. In a consensus workshop, the staff group discussed practical ways the BCTs might work in primary care practice. Fourteen UK policy and practice leaders worked with the researchers to develop recommendations from the consensus workshop into a policy briefing. In conclusion, this study provides detail on using a theory-informed approach to translate research into policy to inform deprescribing practices.