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

Cathal A Cadogan,Gerard J Gormley,Jill J Francis,Carmel M Hughes,Ngaire Kerse,Cristín Ryan,Peter Passmore

doi:10.1186/s12913-016-1907-3

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.

Highlights

It is advocated that interventions to improve clinical practice should be developed using a systematic approach and intervention development methods should be reported
Based on the analysis of qualitative Theoretical Domains Framework (TDF)-based interviews that were conducted with a purposive sample of Healthcare professional (HCP) (15 General practitioner (GP), 15 community pharmacists), eight key domains were selected to be targeted as part of an intervention involving GPs and/or community pharmacists: ‘Skills’, ‘Beliefs about capabilities’, ‘Beliefs about consequences’, ‘Environmental context and resources’, ‘Memory, attention and decision processes’, ‘Social/professional role and identity’, ‘Social influences’, ‘Behavioural regulation’
Based on the contextual information from the analysis of the qualitative interviews, it was evident that in order for the intervention to be feasible and acceptable to HCPs, it would have to be time-efficient and easy to incorporate into routine clinical practice

Summary

Introduction

It is advocated that interventions to improve clinical practice should be developed using a systematic approach and intervention development methods should be reported. In developing interventions to improve clinical practice, it is advocated that researchers should adopt a systematic approach and provide explicit reporting of the intervention development process [1]. Systematic literature reviews can help in identifying, appraising and pooling available evidence. This can aid the selection of intervention components, as well as outcome measures to include as part of the overall evaluation. Established systematic review methodologies exist which have been extensively detailed in the literature, the methods involved in identifying and/or developing appropriate theory are much less clear [5]. A recognised limitation of the MRC framework is that it does not provide guidance on how theory can be incorporated into the intervention development process [6]

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Results

Discussion

Conclusion