Appropriate Prescribing for older adults with Multimorbidity (Pro-M): protocol for a feasibility study

• Published in: Archives of public health = Archives belges de santé publique 2024-03, Vol.82 (1), p.37-37, Article 37
• Main Authors: Tang, Jia Ying, Teng, Poh Hoon June, Chen, Christine Yuanxin, Tan, Keng Teng, Ang, Wendy, Lau, Sabrina, Ang, Alexis Guat Cheng, Kyaw, Kay Khine, Tay, Xin Yong, Lim, Wan Min Stephanie, Espeleta, Wrenzie Del Valle, Lin, Huimin, Ding, Yew Yoong, Lun, Penny
• Format: Article
• Language: English
• Subjects: Aged; Analysis; Chronic illnesses; Clinics; Collaboration; Comorbidity; Continuity of care; Cost analysis; Data collection; Data entry; Drugs; Feasibility studies; Feasibility study; Geriatrics; Hospitals; Intervention; Medication review; Older adults; Older people; Outpatient care facilities; Patients; Pharmacists; Physicians; Polypharmacy; Potentially inappropriate prescribing; Practice guidelines (Medicine); Prescription writing; Proctor’s implementation outcomes; Study Protocol; Sustainable development
• ISSN: 0778-7367; 2049-3258; 2049-3258
• DOI: 10.1186/s13690-024-01264-x

Potentially inappropriate prescribing is common among older adults with multimorbidity due to various reasons, from concurrent application of multiple single-disease clinical guidelines to fragmentation of care. Interventions such as medication review have been implemented worldwide to reduce inappropriate prescribing for older adults. However, the implementability of such interventions are underexplored in the outpatient clinics in Singapore's public hospitals. Hence, the Pro-M study aims to assess the feasibility of implementing a physician-pharmacist collaborative care intervention in geriatric medicine outpatient clinics to facilitate appropriate prescribing for older adults in Singapore. This is a single-arm, non-randomised feasibility study using a pre-post evaluation design. This study consists of two parts: (1) implementation phase of the intervention (6 months) and an (2) evaluation phase (3 months). Eligible patients will be recruited from geriatric medicine outpatient clinics at two public hospitals in Singapore through convenience sampling. The main components of the Pro-M intervention are: (1) pharmacist-facilitated medication reviews with feedback on any medication issues and potential recommendations to physicians, and (2) physicians communicating changes to other relevant prescribers. The evaluation phase will involve surveying and interviewing physicians and pharmacists involved in the implementation of the intervention. A mixed-method approach will be employed for data collection and analysis. The quantitative and qualitative findings will be triangulated and reported using Proctor's implementation outcomes: appropriateness, penetration, acceptability, fidelity, feasibility, and sustainability. A basic cost analysis will be conducted alongside the study. This is a phase 2 study to test the feasibility of implementing an intervention that was co-created with stakeholders during phase 1 development of an intervention to optimise prescribing for older adults with multimorbidity. The implementation will be assessed using Proctor's implementation outcomes to provide insights on the process and the feasibility of implementing medication reviews for older adults with multimorbidity as a routine practice in outpatient clinics. Data collected from this study will inform a subsequent scale-up study. ClinicalTrials.gov Identifier: NCT05756478. Registered on 06 March 2023.