Browsing by Author "Alharthi, Mohammed S"

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Development of pharmacists’ deprescribing role in care home setting
(2023-01-15) Alharthi, Mohammed S; Wright, David
Background Care Homes Independent Pharmacist Prescribing Study (CHIPPS), hypothesising the benefit to care home residents from medicines management by pharmacist independent prescribers (PIPs), found no impact on the primary outcome measure of falls. This thesis aimed to explain these results from recorded PIP medication review (MR) activities and provide recommendations for enhanced effectiveness of pharmacists with prescribing rights in care homes. An identified lack of MR activities standardised terms resulted in development of an international taxonomy. Aims 1. Explain CHIPPS outcomes. 2. Explain relationship between PIPs deprescribing activities and context. 3. Create a taxonomy of terms resulting from MR activities. Methods Quantitative analysis of CHIPPS medication review data relating activity to contextual factors. Secondary qualitative analysis of PIPs interviews within CHIPPS to understand barriers/enablers to deprescribing. Systematic review to identify terms/definitions to describe MR activities. Consensus methodology with international experts to develop MR activity taxonomy. Results PIPs activities involved 326 (72.6%) CHIPPS participants. A total of 284 (50.2%) clinical activities involved deprescribing, 249 (87.7%) being proactive. There was a 25% reduction in falls risk. The significant predictor for deprescribing was PIP employment by GP. Social influences, beliefs about capabilities, social/professional role and identity, environmental context and resources, and beliefs about consequences were key influencers of PIP deprescribing. Consensus MR activities terms included discontinue, start, dose increase, dose decrease, change timing, change formulation and monitor. Conclusion Falls was a sub-optimal primary outcome measure for CHIPPS because only a quarter of PIPs activities related to medications likely to reduce falls risk. PIPs in medical practices were more likely to undertake deprescribing activities; barriers/enablers identified from interview analysis explained this relationship. Taxonomy developed in this thesis, based on the consensus of experts across four countries, can be used by researchers to enable a consistent approach to process comparison within trials to identify differences.
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