A feasibility study of a theory-based intervention to improve appropriate polypharmacy for older people in primary care

Abstract Background Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. Methods This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. Results A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Conclusion Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Trial registration Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).

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Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

10.21203/rs.3.rs-59646/v1 ◽

2020 ◽

Author(s):

Eva Seckler ◽

Verena Regauer ◽

Melanie Krüger ◽

Anna Gabriel ◽

Joachim Hermsdörfer ◽

...

Keyword(s):

Primary Care ◽

Data Collection ◽

Older People ◽

Process Evaluation ◽

Feasibility Study ◽

Health Professionals ◽

Implementation Strategy ◽

Care Pathway ◽

Balance Disorders ◽

Telephone Helpline

Abstract BackgroundCommunity-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a Care Pathway (CPW) to improve their mobility and participation by offering standardised approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial.MethodsThis 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s guidance for developing and evaluating complex interventions. Patients with VDB (≥ 65 years), GPs and PTs in primary care were included. Intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. Implementation strategy contained specific educational trainings and a telephone helpline. Data for mixed-method process evaluation was collected via standardised questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data via content analysis.ResultsA total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rate GP practices: 27,8%; PT practices: 38,5%). 91% of patients and all health professionals completed the study. The health professionals responded well to the educational trainings, the utilization of the telephone helpline was low (one call each from GPs and PTs). Routine in the intervention’s application and positive attitudes were emphasised as facilitators for the interventions’ implementation, whereas lack of time was mentioned as a barrier. Despite of difficulties in GPs’ adherence to intervention protocol, GPs, PTs and patients benefited from the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences.ConclusionAlthough the process evaluation provides good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need of improvement in recruitment, the GPs’ intervention part and data collection procedures. Findings will inform the main trial to prove the interventions effectiveness in a cluster RCT.Trial registrationDeutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered); Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017

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Promoting independence, health and well-being for older people: a feasibility study of computer-aided health and social risk appraisal system in primary care

BMC Family Practice ◽

10.1186/s12875-017-0620-6 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 8

Author(s):

Kate Walters ◽

Kalpa Kharicha ◽

Claire Goodman ◽

Melanie Handley ◽

Jill Manthorpe ◽

...

Keyword(s):

Primary Care ◽

Older People ◽

Feasibility Study ◽

Well Being ◽

Social Risk ◽

Appraisal System ◽

Risk Appraisal ◽

Computer Aided ◽

Health And Well Being

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Promoting health and wellbeing for older people in primary care: a feasibility study

The Lancet ◽

10.1016/s0140-6736(13)62524-6 ◽

2013 ◽

Vol 382 ◽

pp. S99

Author(s):

Kate Walters ◽

Kalpa Kharicha ◽

Steve Iliffe ◽

Claire Goodman ◽

Melanie Handley ◽

...

Keyword(s):

Primary Care ◽

Older People ◽

Feasibility Study ◽

Health And Wellbeing

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A primary care intervention helps older people with depression

10.3310/signal-000535 ◽

2018 ◽

Author(s):

Keyword(s):

Primary Care ◽

Older People ◽

Care Intervention

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Anticipatory Care Planning Intervention for Older Adults at Risk of Functional Decline: A Primary Care Feasibility Study

Case Medical Research ◽

10.31525/ct1-nct03902743 ◽

2019 ◽

Author(s):

Keyword(s):

Older Adults ◽

Primary Care ◽

At Risk ◽

Feasibility Study ◽

Functional Decline ◽

Care Planning ◽

Planning Intervention

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An external pilot cluster randomised controlled trial of a theory-based intervention to improve appropriate polypharmacy in older people in primary care (PolyPrime): study protocol

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00822-2 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Audrey Rankin ◽

◽

Cathal A. Cadogan ◽

Heather E. Barry ◽

Evie Gardner ◽

...

Keyword(s):

Primary Care ◽

Randomised Controlled Trial ◽

Older People ◽

Usual Care ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Online Video ◽

Link Type ◽

Cluster Randomised ◽

Randomised Controlled

Abstract Background The use of multiple medications (polypharmacy) is a concern in older people (≥65 years) and is associated with negative health outcomes. For older populations with multimorbidity, polypharmacy is the reality and the key challenge is ensuring appropriate polypharmacy (as opposed to inappropriate polypharmacy). This external pilot cluster randomised controlled trial (cRCT) aims to further test a theory-based intervention to improve appropriate polypharmacy in older people in primary care in two jurisdictions, Northern Ireland (NI) and the Republic of Ireland (ROI). Methods Twelve GP practices across NI (n=6) and the six counties in the ROI that border NI will be randomised to either the intervention or usual care group. Members of the research team have developed an intervention to improve appropriate polypharmacy in older people in primary care using the Theoretical Domains Framework of behaviour change. The intervention consists of two components: (1) an online video which demonstrates how a GP may prescribe appropriate polypharmacy during a consultation with an older patient and (2) a patient recall process, whereby patients are invited to scheduled medication review consultations with GPs. Ten older patients receiving polypharmacy (≥4 medications) will be recruited per GP practice (n=120). GP practices allocated to the intervention arm will be asked to watch the online video and schedule medication reviews with patients on two occasions; an initial and a 6-month follow-up appointment. GP practices allocated to the control arm will continue to provide usual care to patients. The study will assess the feasibility of recruitment, retention and study procedures including collecting data on medication appropriateness (from GP records), quality of life and health service use (i.e. hospitalisations). An embedded process evaluation will assess intervention fidelity (i.e. was the intervention delivered as intended), acceptability of the intervention and potential mechanisms of action. Discussion This pilot cRCT will provide evidence of the feasibility of a range of study parameters such as recruitment and retention, data collection procedures and the acceptability of the intervention. Pre-specified progression criteria will also be used to determine whether or not to proceed to a definitive cRCT. Trial registration ISRCTN, ISRCTN41009897. Registered 19 November 2019. ClinicalTrials.gov, NCT04181879. Registered 02 December 2019.

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An innovative approach to improve the detection and treatment of risk factors in poor urban settings: a feasibility study in Argentina

BMC Public Health ◽

10.1186/s12889-021-10569-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Poggio Rosana ◽

Goodarz Danaei ◽

Laura Gutierrez ◽

Ana Cavallo ◽

María Victoria Lopez ◽

...

Keyword(s):

Public Health ◽

Risk Factors ◽

Primary Care ◽

Community Health ◽

Community Health Workers ◽

Feasibility Study ◽

Health Workers ◽

Health Coverage ◽

Cvd Risk Factors ◽

Cvd Risk

Abstract Background The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). Methods We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were having exclusive public health coverage, age ≥ 40 years, residence in the PCC’s catchment area and 10-year CVD risk ≥10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC’s staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs). Results A total of 185 participants were included in the study. Of the total number of eligible participants, 82.2% attended at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21 to 32.6% in hypertensive participants, 7.4 to 33.3% in high CVD risk and 1.4 to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP < 140/90 mmHg) increased from 20.3 to 35.5%. Conclusion The proposed CHWs-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs did not only stimulate teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.

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Do statins reduce mortality in older people? Findings from a longitudinal study using primary care records

Family Medicine and Community Health ◽

10.1136/fmch-2020-000780 ◽

2021 ◽

Vol 9 (2) ◽

pp. e000780

Author(s):

Lisanne Andra Gitsels ◽

Ilyas Bakbergenuly ◽

Nicholas Steel ◽

Elena Kulinskaya

Keyword(s):

Primary Care ◽

Older People ◽

Clinical Information ◽

Cardiac Risk ◽

Health Improvement ◽

Network Database ◽

Statin Prescription ◽

The Health Improvement Network ◽

Care Practices ◽

Primary Care Practices

ObjectiveAssess whether statins reduce mortality in the general population aged 60 years and above.DesignRetrospective cohort study.SettingPrimary care practices contributing to The Health Improvement Network database, England and Wales, 1990–2017.ParticipantsCohort who turned age 60 between 1990 and 2000 with no previous cardiovascular disease or statin prescription and followed up until 2017.ResultsCurrent statin prescription was associated with a significant reduction in all-cause mortality from age 65 years onward, with greater reductions seen at older ages. The adjusted HRs of mortality associated with statin prescription at ages 65, 70, 75, 80 and 85 years were 0.76 (95% CI 0.71 to 0.81), 0.71 (95% CI 0.68 to 0.75), 0.68 (95% CI 0.65 to 0.72), 0.63 (95% CI 0.53 to 0.73) and 0.54 (95% CI 0.33 to 0.92), respectively. The adjusted HRs did not vary by sex or cardiac risk.ConclusionsUsing regularly updated clinical information on sequential treatment decisions in older people, mortality predictions were updated every 6 months until age 85 years in a combined primary and secondary prevention population. The consistent mortality reduction of statins from age 65 years onward supports their use where clinically indicated at age 75 and older, where there has been particular uncertainty of the benefits.

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