Development and implementation of NHS programmes to reduce preventable harm from polypharmacy


Large-scale Sustainable Change
Pharmacist and Data-driven Quality Improvement in Primary care (P-DQIP) - Mixed methods evaluation to inform the development and implementation of                              NHS programmes to address the problem of preventable drug-related                                                morbidity in older people

 


Completed work: Optimising polypharmacy using the Pharmacist and Data-driven Quality Improvement in Primary Care (P-DQIP) intervention: A qualitative exploration of pharmacists’ perceived barriers and facilitators to inform its implementation

We conducted 14 semi-structured face-to-face interviews were conducted with practice pharmacists using an interview topic guide based on the Theoretical Domains Framework to:

(1) Identify barriers and facilitators to the adoption of P-DQIP by general practices from the perspective of practice pharmacists.
(2) Identify strategies to overcome barriers and/or enhance facilitators based on the practice pharmacists recommendations.
(3) Link identified barriers and facilitators to key theoretical domains and map these on to behaviour change techniques that are relevant to support how pharmacists review and manage risky drug therapy.


Ongoing work: Pharmacist and Data-driven Quality Improvement in Primary care (P-DQIP) - Mixed methods evaluation to inform the development and implementation of NHS programmes to address the problem of preventable drug-related morbidity in older people.
 


What we know

On the basis of previously tested interventions, SISCC and NHS Tayside co-developed the ‘Pharmacist and Data-driven Quality Improvement in Primary care (P-DQIP)’ programme.  The P-DQIP programme will be rolled out across all general practices in NHS Tayside.

The P-DQIP intervention comprises of four elements:

(1)    Case-finding support to facilitate identification of patients at high risk of drug related harm.
(2)    Decision support to facilitate identification of drug therapy risks at individual patient level.
(3)    Pharmacist support to increase review capacity in general practices.
(4)    Ongoing feedback on levels of high-risk prescribing and review activity to create and maintain momentum in reviewing and managing high-risk prescribing.


What this research explores

This project has currently been suspended due to COVID-19; but the mixed-methods evaluation of the P-DQIP prescribing improvement programme, will recommence to conduct:

(1)    a segmented regression analysis of interrupted time series data;
(2)    an economic evaluation;
(3)    a quantitative process evaluation;
(4)    a qualitative process evaluation.

Study Population: General practices in NHS Tayside and registered patients aged 75 years and older
Sample Size: Approximately 57 out of 65 practices already agreed to take part
Planned study Period: 36 months study (18 months before and 18 months after the implementation of the P-DQIP prescribing improvement programme)


What this study will add

Study 1 (Effectiveness): To evaluate the impact of the intervention on high-risk prescribing (effectiveness). All practices in NHS Tayside will be invited to participate. We will analyse quantitative data on primary and secondary outcomes and conduct segmented regression of time series data, comparing levels and trends in respective primary and secondary outcomes during 18 months before versus 18 months after the implementation of the P-DQIP programme.

Study 2 (Cost-Effectiveness): To examine the cost-effectiveness of the intervention. We will estimate the cost of implementing the P-DQIP programme per change in person time of exposure to high-risk prescribing before versus after the implementation of the intervention.

Study 3 (Quantitative Process Evaluation): To examine variation P-DQIP implementation and effectiveness at practice level.
Part 1 - All practices in NHS Tayside will be invited to participate. We will examine variation in implementation processes, review performance and outcomes and associations between implementation processes, review performance and outcomes.
Part 2 - We will examine implementation processes via an online survey to be completed by general practitioners and pharmacists 6 months post-implementation (P-DQIP online survey). 

Study 4 (Qualitative Process Evaluation): To examine barriers and facilitators to the implementation of P-DQIP and inform its wider implementation:
(1) Discussions among pharmacists participating in half-day workshops will be observed as part of a formative ethnographic study.
(2) Based on levels of P-DQIP implementation (high-risk prescribing and review activity), health care professionals will be sampled from those practices participating in Study 1, 2 and 3  to participate in semi-structured interviews.


Collaborators

This project is led by Professor Tobias Dreischulte, Professor of Clinical Health Services Research, University of Munich, in conjunction with colleagues from the School of Health Sciences at the University of Dundee.  This work will involve primary care staff from NHS Tayside. 


For more information please contact  SISCC (siscc@dundee.ac.uk
)


Related Publications:

Pharmacist and Data-Driven Quality Improvement in Primary Care (P-DQIP): a qualitative study of anticipated implementation factors informed by the Theoretical Domains Framework (2020) 

Safer Prescribing - A Trial of Education, Informatics, and Financial Incentives (2016) 

Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial (2016)

The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995–2010 (2015)

High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice (2011) 

Summary of the DQIP2 project (2011)


Links
:

Achieving excellence in pharmaceutical care: a strategy for Scotland

Polypharmacy Guidance – Medicines Review

Effective Prescribing and Therapeutics

The polypharmacy programme in Scotland: realistic prescribing 

Scottish Patient Safety Programme - Medicines