The feasibility of implementing a hospital deprescribing behaviour change intervention and undertaking trial processes: a mixed methods evaluation

BACKGROUND: CompreHensive geriAtRician-led MEdication Review (CHARMER) is a behaviour change intervention designed to address the determinants of geriatricians and pharmacists deprescribing in hospital. CHARMER comprises a deprescribing action plan, deprescribing briefings, videos of successful deprescribing consultations, deprescribing case studies workshop and a deprescribing performance dashboard. This study aimed to evaluate the feasibility of undertaking a CHARMER definitive trial and inform primary outcome measure selection (90-day hospital readmission or patient quality of life (QoL)).

METHODS: A two-arm purposive allocation feasibility study was undertaken in four hospitals (three intervention, one control). Intervention fidelity and acceptability, outcome data completeness and quality were evaluated alongside acceptability of data collection methods. The process evaluation explored these via interviews with staff and patients. Data were used to inform primary outcome measure selection.

RESULTS: Eighteen geriatricians and pharmacists received the CHARMER intervention and 318 patients admitted to study wards were enrolled. 90-day hospital readmission data were available for 290 (91.2 %) patients. Sixty-six (20.8 %) were approached for consent to complete QoL measures; 25 (37.9 %) consented and 13 (52 %) completed at baseline and 90-day follow up. All intervention components were implemented with acceptable fidelity; hospitals were unfamiliar with implementing action plans and unclear who should be involved with implementing the dashboard, leading to delays.

CONCLUSIONS: The CHARMER intervention is feasible to implement and given the low patient consent rate, 90-day readmission rate is the most appropriate primary outcome measure. Minor refinements to guidance will facilitate hospitals to undertake activities for implementation that are unfamiliar.

CLINICAL TRIAL REGISTRATION: The study was registered on ISRCTN (ISRCTN11899506).