Overview

CHARMER stands for CompreHensive geriAtRician led MEdication Review, and is funded by the UK’s National Institute for Health and Care Research (NIHR).

CHARMER is a five-year (2020-2025) England-wide research project to develop and test an approach to increasing discussions with older hospital patients about stopping medicines that are no longer useful and could be harmful.

Our aim is to help ensure that patients over the age of 65 who take several medicines have them all reviewed whenever they are admitted to hospital. Nearly all patients have told us that their hospital stay is a missed opportunity to review their medicines. We have worked with hospital doctors and pharmacists working with older adults to identify why a review doesn’t always happen and developed strategies to support them to make it happen. We are now working with 24 hospitals to see how well it works.

Our approach encourages proactive deprescribing – this refers to stopping medicines before they cause harm. This is supported by the World Health Organisation in contrast to reactive deprescribing which is stopping a medicine in response to present harm, e.g., when side effects of a medicine cause a person to have a fall. 

Our goals are to:

  • reduce the possibility of medicines doing harm to older patients
  • minimise the daily burden from taking unnecessary medicines
  • enhance older patient’s quality of life

Our Earlier Research

To ensure that proactive deprescribing routinely happens in hospitals we first had to find out why it doesn’t happen already. Working with 54 geriatricians (hospital doctors who care for older people) and pharmacists, we found one thing that helps and four things that hinder them from proactively stopping medicines. These include:

  • Drawing attention to staff who are succeeding in stopping unnecessary or risky medicines (helps)
  • Misconception by hospital doctors that patients and carers don’t want to stop their medicines (hinders)
  • Pharmacists being unavailable when stopping decisions could be made (hinders)
  • Pharmacists’ thinking that doing nothing is safer than stopping a medicine (hinders)
  • Perception that medicine stopping is not a hospital priority (hinders)

We have since worked with hospital doctors, pharmacists, other hospital staff (e.g., Improvement Managers) and patients to identify and design strategies to remove these obstacles and encourage more proactive deprescribing. The following five strategies form the CHARMER intervention:

  1. A workshop for pharmacists including videos of patient case studies
  2. A deprescribing meeting between pharmacists and geriatricians
  3. Videos of geriatricians holding various deprescribing consultations
  4. A hospital action plan that prioritises deprescribing
  5. A technique to record and compare deprescribing activities

We trialled these strategies (and our wider study processes, including things like patient data collection) in a small number of hospitals which confirmed that they are feasible and acceptable. This is called feasibility testing, which you can read more about here.

Next steps – the CHARMER trial

We are now trialing the CHARMER intervention in 24 hospitals across England. The CHARMER trial started on 1 February 2024 and will run until Summer 2025.

If the trial shows the CHARMER intervention is successful, we will work with NHS England to roll it out across the NHS.

Collaborating Organisations