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Iterative Development of Clinician Guides to Support Deprescribing Decisions and Communication for Older Patients in Hospital: A Novel Methodology

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Abstract

Background/Objectives

Medication review is an important component of the management of older hospital patients. Deprescribing (supervised withdrawal of inappropriate medicines) is one outcome of review. This study aimed to iteratively develop and test the usability of deprescribing guides, which support multidisciplinary clinicians to reduce inappropriate polypharmacy in older inpatients.

Methods

Deprescribing guides for hospital clinicians were developed using a novel mixed-methods, ten-step process. Iterative development and usability testing were applied. This included content development through review of the literature; expert consensus through five rounds of feedback using a modified Delphi approach; and usability testing by 16 multidisciplinary hospital clinicians on hypothetical clinical scenarios involving observations, semi-structured interviews, and administration of the System Usability Scale.

Results

This novel process was used to develop deprescribing guides that facilitate implementation of evidence on deprescribing in routine hospital care. The guides present evidence-based information in a format that aligns with workflows of multidisciplinary hospital clinicians. The guides were adapted for various clinical roles to navigate efficiently to suit differing workflow needs. Guides include unique communication support in the form of “preferred language”. Clinicians can use the “preferred language” to apply the evidence to the individual patient and relay decisions between health providers and with patients/carers. The total System Usability Scale score was 80.6 ± 2.0 (mean ± standard error of the mean), indicating excellent usability. Guides have been developed using consistent format for nine medication classes that are common targets for deprescribing and are publicly available.

Conclusion

This study demonstrates a novel approach to the development and implementation of evidence-based recommendations that support deprescribing in routine hospital care.

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Acknowledgements

We thank all study participants, panel reviewers and research staff for their time and contributions. We acknowledge Dr. Brendan Ng and Ms. Linda Koria for their feedback. Forte Inc. is acknowledged for their contribution to graphic design.

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Authors and Affiliations

  1. Kolling Institute, Royal North Shore Hospital and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    M. H. Duong, N. Jokanovic & S. N. Hilmer

  2. School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    A. J. McLachlan & D. Gnjidic

  3. NSW Therapeutic Advisory Group, Sydney, NSW, Australia

    A. A. Bennett

  4. Anzac Research Institute, Concord Hospital and Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    D. G. Le Couteur

  5. Sydney School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    M. T. Baysari

  6. School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    F. Blyth

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  1. M. H. Duong
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Corresponding author

Correspondence to S. N. Hilmer.

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Funding

This work is part of a larger research project entitled “Reducing inappropriate polypharmacy in older inpatients Translational Research Grant 274” funded by NSW Health. DG is supported by the Australian National Health and Medical Research (NHMRC) Dementia Leadership Fellowship.

Conflict of interest

The authors, MD, AM, AB, NJ, DLC, MB, DG, FB, and SH, declare that they have no conflicts of interest relevant to the contents of this article.

Ethics approval

Northern Sydney Local Health District Human Research Ethics Committee (LNR/17/HAWKE/138).

Consent to participate

All participants provided informed written consent.

Consent for publication

The final version of the approved manuscript was approved for submission by all authors.

Availability of data and material

Data are available from the corresponding author upon receipt of reasonable requests.

Authors’ contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MD, NJ, MB, and SH. The first draft of the manuscript was written by MD. All authors commented on previous versions of the manuscript. The final drafts of the manuscript were written by SH. All authors read and approved the final manuscript. SH supervised all aspects of the study.

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Duong, M.H., McLachlan, A.J., Bennett, A.A. et al. Iterative Development of Clinician Guides to Support Deprescribing Decisions and Communication for Older Patients in Hospital: A Novel Methodology. Drugs Aging 38, 75–87 (2021). https://doi.org/10.1007/s40266-020-00820-8

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