Understanding stakeholders’ perspectives on implementing deprescribing for older people living in long-term residential care homes: the STOPPING study protocol

Abstract

Background: Older people with multimorbidity often experience polypharmacy. Taking multiple medicines can be beneficial; however, some older adults are prescribed multiple medicines when they are unlikely to improve clinical outcomes and may lead to harm. Deprescribing means reducing or stopping prescription medicines which may no longer be providing benefit. While appropriate deprescribing may usually be safely undertaken, there is a lack of guidance about how to implement it in practice settings such as care homes. Implementing deprescribing in care homes is often challenging, due to differing concerns of residents, staff, clinicians, friends/family members and carers along with differences in care home structures. The STOPPING study will support the development of better deprescribing practice in care homes, considering different views and environments. This paper aims to introduce the research protocol. Methods: We will use qualitative approaches informed by the widely accepted Consolidated Framework for Implementation Research (CFIR) to aid analysis. To understand the barriers, facilitators, and contextual factors influencing deprescribing in care homes, we will employ individual interviews with care home residents and family members, focus groups with care home staff and healthcare professionals, and observations from care homes. Then, we will examine acceptability, feasibility, and suitability of existing deprescribing approaches using cognitive interviews with care home staff and healthcare professionals. Lastly, we will use narrative synthesis to integrate findings and develop guidance for implementing a deprescribing approach for care homes. Discussion: This research will support the development of implementable approaches to deprescribing in care homes. The insights from this project will be shared with various stakeholders: care home residents, staff, pharmacists, general practitioners, nurses, and other health professionals, carers, researchers, and the public. This work will support deprescribing to be implemented effectively in care homes to benefit residents and the wider health economy.

Determinants of implementing deprescribing for older adults in English care homes: a qualitative interview study

“…19 31 A better understanding of how contextual factors facilitate or hinder deprescribing, informed by an implementation framework, is needed to support the translation of deprescribing recommendations into practice. 32 33 The present study presents the findings of the first work package of the STOPPING project (for the original protocol, see Warmoth et al 34 ). The overall aim was to investigate the factors which influence deprescribing for older adults in care homes.…”

“…Some limitations of the study must be acknowledged. Due to the COVID-19 pandemic, care home observations and focus groups were not conducted, which had been originally planned 34 ; this could have provided a better understanding of everyday practices and insight into experiences than interviews alone. Future work could adopt an ethnographic approach to explore the culture of deprescribing in care homes and observe deprescribing conversations and behaviours.…”

“…The present study presents the findings of the first work package of the STOPPING project (for the original protocol, see Warmoth et al 34). The overall aim was to investigate the factors which influence deprescribing for older adults in care homes.…”

Determinants of Implementing Deprescribing for Older Adults in English Care Homes: A Qualitative Study

“…Some limitations of the study must be acknowledged. Due to the COVID-19 pandemic, care home observations and focus groups were not conducted, which had been originally planned (30); this could have provided a better understanding of everyday practices and insight into experiences than interviews alone. Future work could adopt an ethnographic approach to explore the culture of deprescribing in care homes and observe deprescribing conversations and behaviours.…”