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Evaluating the impact of a polypharmacy Action Learning Sets tool on healthcare practitioners’ confidence, perceptions and experiences of stopping inappropriate medicines

Evaluating the impact of a polypharmacy Action Learning Sets tool on healthcare practitioners’ confidence, perceptions and experiences of stopping inappropriate medicines
Evaluating the impact of a polypharmacy Action Learning Sets tool on healthcare practitioners’ confidence, perceptions and experiences of stopping inappropriate medicines

Background: issues of medication adherence, multimorbidity, increased hospitalisation risk and negative impact upon quality of life have led to the management of polypharmacy becoming a national priority. Clinical guidelines advise a patient-centred approach, involving shared decision-making and multidisciplinary team working. However, there have been limited educational initiatives to improve healthcare practitioners’ management of polypharmacy and stopping inappropriate medicines. This study aimed to evaluate the impact of a polypharmacy Action Learning Sets (ALS) tool across five areas: i. healthcare practitioners’ confidence and perceptions of stopping medicines; ii. knowledge and information sources around stopping medicines; iii. perception of patients and stopping medicines; iv. perception of colleagues and stopping medicines and v. perception of the role of institutional factors in stopping medicines. 

Methods: the ALS tool was delivered to a multi-disciplinary group of healthcare practitioners: GPs [n = 24] and pharmacy professionals [n = 9]. A pre-post survey with 28 closed statements across five domains relating to the study aims [n = 32] and a post evaluation feedback survey with 4 open-ended questions [n = 33] were completed. Paired pre-post ALS responses [n = 32] were analysed using the Wilcoxon signed-rank test. Qualitative responses were analysed using a simplified version of the constant comparative method. 

Results: the ALS tool showed significant improvement in 14 of 28 statements in the pre-post survey across the five domains. Qualitative themes (QT) from the post evaluation feedback survey include: i. awareness and management of polypharmacy; ii. opportunity to share experiences; iii. usefulness of ALS as a learning tool and iv. equipping with tools and information. Synthesised themes (ST) from analysis of pre-post survey data and post evaluation feedback survey data include: i. awareness, confidence and management of inappropriate polypharmacy, ii. equipping with knowledge, information, tools and resources and iii. decision-making and discussion about stopping medicines with colleagues in different settings. 

Conclusions: this evaluation contributes to developing understanding of the role of educational initiatives in improving inappropriate polypharmacy, demonstrating the effectiveness of the ALS tool in improving healthcare practitioners’ awareness, confidence and perceptions in stopping inappropriate medicines. Further evaluation is required to examine impact of the ALS tool in different localities as well as longer-term impact.

Action learning sets tool, Education, GP, Healthcare practitioners, Pharmacists, Pharmacy professionals, Polypharmacy
1472-6920
Brooks, Cindy
8a2fcddf-44b1-4f74-a14f-d877dddf58bd
Argyropoulos, Anastasios
bb30eb54-3ad3-4459-aa5d-9d058b8e7f4e
Matheson, Catherine
609d16bf-fe81-4fcd-8f6c-91431c55a9fc
Kryl, David
59a96168-a261-49c8-9c40-d124f6c83daf
Brooks, Cindy
8a2fcddf-44b1-4f74-a14f-d877dddf58bd
Argyropoulos, Anastasios
bb30eb54-3ad3-4459-aa5d-9d058b8e7f4e
Matheson, Catherine
609d16bf-fe81-4fcd-8f6c-91431c55a9fc
Kryl, David
59a96168-a261-49c8-9c40-d124f6c83daf

Brooks, Cindy, Argyropoulos, Anastasios, Matheson, Catherine and Kryl, David (2022) Evaluating the impact of a polypharmacy Action Learning Sets tool on healthcare practitioners’ confidence, perceptions and experiences of stopping inappropriate medicines. BMC Medical Education, 22 (1), [499]. (doi:10.1186/s12909-022-03556-8).

Record type: Article

Abstract

Background: issues of medication adherence, multimorbidity, increased hospitalisation risk and negative impact upon quality of life have led to the management of polypharmacy becoming a national priority. Clinical guidelines advise a patient-centred approach, involving shared decision-making and multidisciplinary team working. However, there have been limited educational initiatives to improve healthcare practitioners’ management of polypharmacy and stopping inappropriate medicines. This study aimed to evaluate the impact of a polypharmacy Action Learning Sets (ALS) tool across five areas: i. healthcare practitioners’ confidence and perceptions of stopping medicines; ii. knowledge and information sources around stopping medicines; iii. perception of patients and stopping medicines; iv. perception of colleagues and stopping medicines and v. perception of the role of institutional factors in stopping medicines. 

Methods: the ALS tool was delivered to a multi-disciplinary group of healthcare practitioners: GPs [n = 24] and pharmacy professionals [n = 9]. A pre-post survey with 28 closed statements across five domains relating to the study aims [n = 32] and a post evaluation feedback survey with 4 open-ended questions [n = 33] were completed. Paired pre-post ALS responses [n = 32] were analysed using the Wilcoxon signed-rank test. Qualitative responses were analysed using a simplified version of the constant comparative method. 

Results: the ALS tool showed significant improvement in 14 of 28 statements in the pre-post survey across the five domains. Qualitative themes (QT) from the post evaluation feedback survey include: i. awareness and management of polypharmacy; ii. opportunity to share experiences; iii. usefulness of ALS as a learning tool and iv. equipping with tools and information. Synthesised themes (ST) from analysis of pre-post survey data and post evaluation feedback survey data include: i. awareness, confidence and management of inappropriate polypharmacy, ii. equipping with knowledge, information, tools and resources and iii. decision-making and discussion about stopping medicines with colleagues in different settings. 

Conclusions: this evaluation contributes to developing understanding of the role of educational initiatives in improving inappropriate polypharmacy, demonstrating the effectiveness of the ALS tool in improving healthcare practitioners’ awareness, confidence and perceptions in stopping inappropriate medicines. Further evaluation is required to examine impact of the ALS tool in different localities as well as longer-term impact.

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Accepted/In Press date: 1 June 2022
Published date: 27 June 2022
Additional Information: Funding Information: This study was funded by the Wessex Academic Health Science Network (Wessex AHSN) and Health Education England (HEE). Funding Information: A special thank you to all those who participated in the evaluation. We also wish to thank Dr Richard Guerrero-Luduena, (Visiting Fellow and former Senior Research Fellow, University of Southampton) for providing analytic support relating to early results in the evaluation. We would also like to thank all those involved in the facilitation of the Polypharmacy Action Learning Sets including: Clare Howard FFRPS FRPharmS Q, (Clinical lead for Medicines Optimisation working with Wessex AHSN), Steven Williams, (Senior Clinical Pharmacist, Poole Bay & Bournemouth Primary Care Network, MPhil, BPharm Hons, Clin Dip Pharm, Pharmacist Independent Prescriber, MRPharmS, Honorary Clinical Lecturer University of Manchester Pharmacy School), Zoe Girdis, BPharm (Sydney Uni) Clin Dip Pharm, (Pharmacist Independent Prescriber, MRPharmS, Consultant to Primary care, Director Formula Zoe Girdis Ltd, Lead Clinical Pharmacist Prescriber Portsmouth North PCN) and Dr Lawrence Brad, (GP Partner and Prescribing lead Westbourne Medical Centre, Fellow of the Royal College of GPs acting as the RCGP Representative for Clinical Pharmacists and for RCP/RPS Medicines Safety Joint Working Group, Clinical teaching fellow at the University of Bath school of Pharmacy and Pharmacology and Wessex LMC GP education programme lead). Furthermore to Ruth George, former Project Support Manager, Wessex AHSN and Vicki Rowse, former Senior Programme Manager, Wessex AHSN. Thank you too to the reviewers and editor for their comments in helping to support revision of this manuscript. Publisher Copyright: © 2022, The Author(s).
Keywords: Action learning sets tool, Education, GP, Healthcare practitioners, Pharmacists, Pharmacy professionals, Polypharmacy

Identifiers

Local EPrints ID: 469171
URI: http://eprints.soton.ac.uk/id/eprint/469171
ISSN: 1472-6920
PURE UUID: 0071b37d-8b70-4c08-bd96-ef7c3a146ea8

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Date deposited: 08 Sep 2022 17:06
Last modified: 08 Sep 2022 17:06

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Contributors

Author: Cindy Brooks
Author: Anastasios Argyropoulos
Author: David Kryl

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