Workstream 3 – Experience-based Co-design of a deprescribing intervention

Research team

Jonathan Silcock, Theo Raynor, Syed Tabish R. Zaidi, Heather Smith, Kate Karban, George Peat, Janice Olaniyan

Collaborations

This Workstream builds on findings from Workstream 1 (the qualitative study of views and experiences of stopping problematic medicines). Findings from this WS3 will help develop an intervention to stop medicines safely, to be evaluated in a future trial (part of Workstream 5)

Why is this project important?

Older patients (65 years and older) and those with a diagnosis of frailty often take multiple medicines and are on complex drug regimens. We also know that sometimes medicines become problematic over time – for example, more medicines increase the risk of side effects due to drug interactions. Stopping medicines is therefore a solution when they have become problematic. However, there is no standardised way to stop medicines safely in primary care, and the process and its results vary widely.

What are we doing?

In this Workstream we collaborated with patients, their supporting peers (i.e. those who help patients manage their medicines at home) and healthcare professionals (i.e. our stakeholders) in several sessions aimed at understanding how to improve the process of stopping medicines in primary care. We used Experience-based Co-design EBCD), a method that is driven by what stakeholders want and need. This is important because any intervention has to have buy-in from both groups and be feasible and workable. We therefore identified components representing important aspects that need to happen when stopping medicines to ensure the process is safe and patients feel supported throughout. We are now using our findings to develop an intervention for implementation and evaluation.

 Patient and public involvement and engagement

In EBCD, we brought together patients, their supporting peers, and healthcare professionals, to discuss our findings, identify priorities when stopping medicines, and co-design our intervention components. PPIE collaboration and engagement was crucial to ensure our findings were grounded on real-life experiences and applicable to the UK primary care context and configuration.

Outputs and impact

We developed a trigger video of patients’ views and experiences that was used in our EBCD session. We continue to use our film for educational purposes, to influence policy and practice, and inspire future healthcare professionals. Additionally, the intervention components co-designed with PPIE will form the basis for our intervention which will be implemented and evaluated as part of Workstream 5.

Contact for more information

Jonathan Silcock, Theo Raynor, George Peat