Aims

In older people’s wards we aim to:

  • develop our approach to increasing discussions with patients about stopping medicines by using what helps and removing what hinders
  • develop a list of things that people think are important to measure when stopping medicines in hospital
  • design and carry out a study testing whether our approach works and is value for money
  • make discussions about stopping medicines in hospital important
  • develop a way for getting our approach to be used in all hospitals

As we get older, our bodies are less able to handle some medicines. Medicines that were once effective and safe, can become less beneficial, with increased risk of harm. Half of older people in hospital are prescribed a medicine with a safety risk, but these medicines are rarely stopped. Nine out of ten patients and carers believe that risky medicines should be stopped in hospital and that doctors should start the discussion.

To make this happen, we need to change doctor and pharmacist behaviour so that the idea of stopping medicines is more likely to be discussed with patients. Our research with 54 doctors and pharmacists working with older people, found one thing that helps (drawing attention to prescribers who successfully stop risky medicines) and four things that hinder (wrong belief that patients don’t want to stop, pharmacists being unavailable when stopping decisions could be made, thinking that doing nothing is safer than stopping and medicine stopping is not a hospital priority).

Plan

We will work with patients, carers, and staff from the hospital and community to develop a way to change pharmacist and doctor behaviour so that risky medicines are more likely to be stopped. They will also help us to design a study comparing hospitals using our approach, with hospitals carrying on as usual. After small-scale testing, we will test our approach in 22 hospitals and see if more medicines are stopped compared to 22 hospitals without our approach.

We will also see whether our approach has benefits to patients, such as preventing hospital readmissions or improving quality of life. We will also calculate the cost of our approach in such a way that the government can compare it with other services. Four patient and public members will be fully involved throughout: from research management and design, to delivery and presentation.

We have designed the study so our approach can be easily taken up in different hospitals and will make the information on how to do this freely available. Throughout the research, we will plan how and with whom to share our findings; this will be led by a public member experienced in changing national practice.

We recognise that any increase in hospital proactive deprescribing due to the CHARMER approach will have an impact on primary care, after the person is discharged. To understand the effects of CHARMER on primary care, we have established a Primary Care Advisory Group. The group meets twice yearly at key time points in the CHARMER project. The focus of the first meetings have been about how we can make sure that hospital proactive deprescribing is effectively communicated to primary care.

CHARMER PCAG Terms of Reference

For further information about the Primary Care Advisory Group, contact charmer.study@le.ac.uk.

jjjjjWorking with our Primary Care Colleagues

Further Reading

The following research studies underpin the CHARMER programme:

Scott S, Clark A, Farrow C, May H, Patel M, Twigg MJ, Wright DJ, Bhattacharya D. Deprescribing admission medication at a UK teaching hospital; a report on quantity and nature of activity. International Journal of Clinical Pharmacy. 2018 Oct 1;40(5):991-6.

Scott S, Clark A, Farrow C, May H, Patel M, Twigg MJ, Wright DJ, Bhattacharya D. Attitudinal predictors of older peoples’ and caregivers’ desire to deprescribe in hospital. BMC geriatrics. 2019 Dec 1;19(1):108.

Scott S, Twigg MJ, Clark A, Farrow C, May H, Patel M, Taylor J, Wright DJ, Bhattacharya D. Development of a hospital deprescribing implementation framework: A focus group study with geriatricians and pharmacists. Age and ageing. 2020 Jan 1;49(1):102-10.

Sion Scott, Helen May, Martyn Patel, David J Wright, Debi Bhattacharya, A practitioner behaviour change intervention for deprescribing in the hospital setting, Age and Ageing, afaa169.

Collaborating Organisations