Development of an intervention to improve appropriate polypharmacy in older people in primary care using a theory-based method

Abstract

BackgroundIt is advocated that interventions to improve clinical practice should be developed using a systematic approach and intervention development methods should be reported. However, previous interventions aimed at ensuring that older people receive appropriate polypharmacy have lacked details on their development. This study formed part of a multiphase research project which aimed to develop an intervention to improve appropriate polypharmacy in older people in primary care.MethodsThe target behaviours for the intervention were prescribing and dispensing of appropriate polypharmacy to older patients by general practitioners (GPs) and community pharmacists. Intervention development followed a systematic approach, including previous mapping of behaviour change techniques (BCTs) to key domains from the Theoretical Domains Framework that were perceived by GPs and pharmacists to influence the target behaviours. Draft interventions were developed to operationalise selected BCTs through team discussion. Selection of an intervention for feasibility testing was guided by a subset of the APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) criteria.ResultsThree draft interventions comprising selected BCTs were developed, targeting patients, pharmacists and GPs, respectively. Following assessment of each intervention using a subset of the APEASE criteria (affordability, practicability, acceptability), the GP-targeted intervention was selected for feasibility testing. This intervention will involve a demonstration of the behaviour and will be delivered as an online video. The video demonstrating how GPs can prescribe appropriate polypharmacy during a typical consultation with an older patient will also demonstrate salience of consequences (feedback emphasising the positive outcomes of performing the behaviour). Action plans and prompts/cues will be used as complementary intervention components. The intervention is designed to facilitate the prescribing of appropriate polypharmacy in routine practice.ConclusionA GP-targeted intervention to improve appropriate polypharmacy in older people has been developed using a systematic approach. Intervention content has been specified using an established taxonomy of BCTs and selected to maximise feasibility. The results of a future feasibility study will help to determine if the theory-based intervention requires further refinement before progressing to a larger scale randomised evaluation.

Improving adherence to multiple medications in older people in primary care: Selecting intervention components to address patient‐reported barriers and facilitators

“…This study formed part of a multiphase research project that aimed to improve treatment outcomes in older patients by targeting HCPs' clinical behaviours [ie appropriate prescribing and dispensing of polypharmacy (≥4 medications) by general practitioners (GPs) and community pharmacists] and patients' medication adherence behaviours. It was intended at the outset of the project that any intervention to improve adherence to multiple medications in older people in primary care would be delivered by community pharmacists.…”

A feasibility study of a theory-based intervention to improve appropriate polypharmacy for older people in primary care

“…Full details of the preliminary work underpinning the intervention’s development are reported in two related papers [16, 17]. Briefly, the intervention development process followed a systematic approach based on the MRC framework by incorporating evidence and theory [15].…”

Developing interventions to improve health: a systematic mapping review of international practice between 2015 and 2016

“…In contrast, a small number of articles identified the target population during the development process. For example, Cadogan et al [44] developed three draft interventions to improve appropriate polypharmacy in older people in primary care targeting patients, general practitioners, and community pharmacists. The research team then screened each draft intervention using the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side effects/safety and Equity (APEASE) criteria [45] and selected general practitioners as the target population for the planned intervention.…”

“…Developers of behaviour change interventions sometimes referred to frameworks of theories, e.g. the Behaviour Change Wheel [45] because they provided a systematic way of analysing behaviour and a comprehensive list of behaviour change techniques to consider [29,44]. The rationale for this was to bring transparency to the process of development and allow for accurate replication and evaluation of the intervention mechanisms [53,55].…”