Author:
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
Abstract
Abstract
Background
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.
Methods
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.
Discussion
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.
Trial registration
ClinicalTrials.gov Identifier: NCT05756478. Registered on 06 March 2023.
Funder
Geriatric Education and Research Institute, Singapore
Publisher
Springer Science and Business Media LLC
Reference39 articles.
1. National Population and Talent Division, Group S. Prime Minister’s Office, Singapore Department of Statistics, Ministry of Home Affairs, Immigration & Checkpoints Authority, Ministry of Manpower (2022) Population in Brief 2022. https://www.strategygroup.gov.sg/files/media-centre/publications/Population-in-Brief-2022.pdf Accessed 30 Jun 2023.
2. Almirall J, Fortin M. The coexistence of terms to describe the Presence of multiple concurrent diseases. J Comorbidity. 2013;3(1):4–9. https://doi.org/10.15256/joc.2013.3.22
3. Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430–9. https://doi.org/10.1016/j.arr.2011.03.003
4. Picco L, Achilla E, Abdin E, Chong SA, Vaingankar JA, McCrone P, et al. Economic burden of multimorbidity among older adults: impact on healthcare and societal costs. BMC Health Serv Res. 2016;16(1). https://doi.org/10.1186/s12913-016-1421-7
5. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):1–10. https://doi.org/10.1186/s12877-017-0621-2