CompreHensive geriAtRician-led MEdication Review (CHARMER): protocol for a feasibility study of a hospital deprescribing behaviour change intervention
Jacqueline M Martin-Kerry,
Ian Kellar,
Allan B Clark,
Katherine Murphy,
Sion Scott,
Debi Bhattacharya,
David Turner,
Johanna Taylor,
David Wright,
Megan Pritchard,
Miles Witham,
David Phillip Alldred,
Martyn Patel,
Erika Sims,
Antony Colles,
Victoria L Keevil,
Bethany Atkins,
Amber Hammond
Affiliations
Jacqueline M Martin-Kerry
School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
Ian Kellar
Department of Psychology, The University of Sheffield, Sheffield, UK
Allan B Clark
Norwich Medical School, University of East Anglia, Norwich, UK
Katherine Murphy
Faculty of Health Science, Department of Medicine, University of Cape Town, Rondebosch, South Africa
Sion Scott
School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
Debi Bhattacharya
School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
David Turner
Norwich Medical School, University of East Anglia, Norwich, UK
Johanna Taylor
Department of Health Sciences, University of York, York, UK
David Wright
Centre for Public Health, Queen`s University Belfast, Belfast, Northern Ireland, UK
Megan Pritchard
Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
Miles Witham
NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
David Phillip Alldred
3 NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford Institute for Health Research, Bradford, UK
Martyn Patel
Older People`s Medicine Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
Erika Sims
operations manager
Antony Colles
Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
Victoria L Keevil
Department of Medicine for the Elderly, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Bethany Atkins
1 Institute for Women`s Health, University College London, London, UK
Amber Hammond
Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
Introduction Over 50% of older adults are prescribed a medicine where the risk of harm outweighs the chances of benefit. During a hospital admission, older adults and carers expect medicines to be reviewed for appropriateness and any inappropriate medicines proactively deprescribed. While the principle of proactive deprescribing is an expectation of good prescribing practice, it is yet to become routine. The CompreHensive geriAtRician-led MEdication Review (CHARMER) study aims to develop and test a five-component behaviour change intervention to equip geriatricians and pharmacists to proactively deprescribe inappropriate medicines with older adults in hospital. This study aims to test the feasibility and acceptability of study processes and CHARMER implementation.Methods and analysis A two-arm purposive allocation feasibility study is being undertaken at four acute hospitals in England, UK (three intervention and one control). The target sample is 400 patients across all hospitals. Primary outcome measures are: (1) participant recruitment rate and (2) participant attrition rate. Secondary outcome measures are: (1) hospital readmission rate; (2) mortality rate and (3) quality of life. Quantitative data will be checked for completeness and quality, and practitioner and patient demographics descriptively analysed. We will undertake a rapid qualitative analysis on observations, interviews and study meeting minutes data. A subsequent thematic analysis will be undertaken with codes mapped to the Theoretical Domains Framework and Normalisation Process Theory. Triangulation of qualitative and quantitative data will be undertaken.Ethics and dissemination Ethics approval was obtained from Wales Research Ethics Committee 1 (IRAS ID 312494) and study approval from the Health Research Authority (22/WA/0087). Informed consent will be sought from all hospital staff involved in data collection activities and for patients involved in enhanced data collection activities. The findings of this study will be disseminated in peer-reviewed journals and conference presentations.Trial registration ISRCTN11899506.
