Process evaluation of a pharmacist‐led intervention aimed at deprescribing and appropriate use of cardiometabolic medication among adult people with type 2 diabetes

Abstract

BackgroundA quasi‐experimental study investigated a pharmacist‐led intervention aimed at deprescribing and medication management among adult patients with type 2 diabetes at risk of hypoglycaemia.ObjectiveTo evaluate the process of implementing the intervention consisting of a tailored clinical medication review (CMR) supported by a training and a toolbox.MethodsMixed‐methods study based on the Grant‐framework, including the domains ‘recruitment’, ‘delivery of intervention’, and ‘response’ of pharmacists and patients. Data collected were: administrative logs, semi‐structured observations of patient consultations (n=8), interviews with pharmacists (n=16), and patient‐reported experience measure (PREM) questionnaires (n=66).ResultsTailored CMRs were conducted largely as intended for 90 patients from 14 pharmacies. Although patient selection based on a medication‐derived hypoglycaemia risk score was considered useful, pharmacists experienced barriers to proposing deprescribing in patients with recent medication changes, without current hypoglycaemic events, or treated by medical specialists. The training and toolbox were evaluated positively by the pharmacists. Overall, patients were satisfied with the CMR.ConclusionPharmacists and patients valued the CMR focusing on deprescribing and medication management. To optimise implementation and effectiveness of the intervention, improvements can be made to the patient selection, pharmacist training and the collaboration between healthcare professionals.

Effects of a multicomponent communication training to involve older people in decisions to DEPRESCRIBE cardiometabolic medication in primary care (CO-DEPRESCRIBE): protocol for a cluster randomized controlled trial with embedded process and economic evaluation

“… Semi-structured interviews will be held with the HCPs intervention teams after follow-up data collection to assess barriers and facilitators for implementing the trained aspects in daily practice. The topic list for the semi-structured interview will be based on the framework from Grant et al [ 57 ], and on earlier work from Baas et al [ 27 ]. For each HCP intervention team, 2 patient consultations will be video- or audio-recorded.…”

“…Based on the barriers perceived by HCPs, the training should provide information on available evidence regarding benefits and risks as well as tools and guidance on discussing possibilities for deprescribing cardiometabolic medication with patients. Previously, a pharmacist-led intervention was developed and tested that was aimed at deprescribing cardiometabolic medication in patients with type 2 diabetes with a high hypoglycemia risk [ 26 , 27 ]. For the intervention, pharmacists conducted a tailored CMR after a 6-hour training on deprescribing cardiometabolic medication using evidence-based guidelines, medication management to prevent adverse events, and skills for conducting patient consultations about deprescribing.…”

“…This intervention led to increased deprescribing of cardiometabolic medication [ 26 ]. The process evaluation indicated that the intervention could be improved to include particularly patients more likely in need of deintensifying cardiometabolic medication [ 27 ]. Furthermore, extending the training on communication skills and how to discuss deprescribing with patients who do not experience adverse effects of their medication could enhance the implementation of deprescribing [ 27 ].…”

Advancing deprescribing: Learnings from the first international conference on deprescribing

“…Five papers relate to deprescribing interventions. Baas et al 13 report a process evaluation of a medication review intervention aimed at deprescribing cardiometabolic medications for patients with type 2 diabetes. Olesen et al 14 describe a deprescribing quality improvement study in Danish general practice, which improved patient self-reported health status.…”