GP registrars' deprescribing in older patients: a non-randomised controlled study.

GPs' deprescribing

Authors

DOI:

https://doi.org/10.33966/hepj.7.1.17351

Abstract

Purpose: To evaluate the effect of a multi-component educational program aimed at improving general practitioner (GP) trainees’ (registrars') deprescribing in patients 65 years and over. The hypothesis was that an educational program would increase registrars' deprescribing of potentially inappropriate medicines (PIMs) in older patients, relative to a control group, six months post-education.

Design: This was a pragmatic, non-randomised, non-equivalent control group design nested within an ongoing cohort study of registrars' practice (the ReCEnT study). The program consisted of an online module, face-to-face sessions for registrars, webinars for their supervisors, and facilitation of the registrar–supervisor dyad, including case-based discussions of deprescribing in teaching meetings. The program was underpinned by the Behaviour Change Wheel framework and delivered to registrars of a single registrar educational/training organisation (other educational/training organisations served as controls). Primary outcome measures were deprescribing any medicines and deprescribing medicines categorised as PIMs. Secondary outcomes were deprescribing of medications taken for three months or more and dose reduction with a view to deprescribing (cessation).

Findings: Data from 779 education-receiving registrars and 438 control registrars were analysed. Intervention group registrars showed no significant increase in deprescribing of any medication compared to controls (interaction aOR 1.00 (95%CI 0.69, 1.46) or of PIMs (aOR 1.29 (95%CI 0.74, 2.24), or significant changes in secondary outcomes.

Research implications: Despite no differences in prescribing, in this analysis, six months post-intervention, aspects of the findings suggest extended observation and further evaluation may be indicated.

Practical implications: The continuation of education for registrars around deprescribing of PIMs is essential. Further investigation is required to assess the effectiveness and efficiency of the behaviour change approach adopted in this study.

Originality/value: The multi-component behaviour change theory-based approach is novel for this educational setting, and this is an initial step in evaluating the approach.

Limitations: The major limitation is that randomisation in the study design was not practicable.

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Author Biographies

Amanda Tapley, University of Newcastle, School of Medicine and Public Health

University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, 2308, Australia.

GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, 2304, Australia.

Parker Magin, University of NewcastleSchool of Medicine and Public Health

Conjoint Professor, Discipline of General Practice, School of Medicine and Public Health, University of Newcastle

Mieke van Driel, University of Queensland

University of Queensland, General Practice Clinical Unit, Faculty of Medicine, Level 8, Health Sciences Building, Royal Brisbane & Women’s Hospital, Brisbane, QLD, 4006, Australia

Billie Bonevski, University of Newcastle, School of Medicine and Public Health

University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, 2308, Australia

Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, SA, 5042, Australia

Elizabeth Holliday, University of Newcastle, School of Medicine and Public Health

University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, 2308, Australia

Jean Ball, Hunter Medical Research Institute (HMRI)

Hunter Medical Research Institute (HMRI), Clinical Research Design and Statistical Support Unit (CReDITSS), New Lambton Heights, NSW, 2305, Australia

Andrew Davey, University of Newcastle, School of Medicine and Public Health

University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, 2308, Australia

GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, 2304, Australia

Stephen Barnett, School of Medicine, University of Wollongong

School of Medicine, University of Wollongong, Northfields Ave Wollongong, NSW, 2522, Australia

Colin Gunter, GP Synergy, Regional Training Organisation (RTO)

GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, 2304, Australia

Jon Fogarty, GP Synergy, Regional Training Organisation (RTO)

GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, 2304, Australia

Rachel Turner, GP Synergy, Regional Training Organisation (RTO)

GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, 2304, Australia

Neil Spike, Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation (RTO)

Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation (RTO), 15 Cato Street, Hawthorn, VIC, 3122, Australia.

University of Melbourne, Department of General Practice and Primary Health Care, 200 Berkeley Street, Carlton, VIC, 3053, Australia.

Monash University, Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Northways Road, Churchill, VIC, 3842, Australia

Kristen Fitzgerald, General Practice Training Tasmania (GPPT), Regional Training Organisation (RTO)

General Practice Training Tasmania (GPPT), Regional Training Organisation (RTO), Level 3, RACT House, 179 Murray Street, Hobart, TAS, 7000, Australia

Anna Ralston, GP Synergy, Regional Training Organisation (RTO)

GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, 2304, Australia

Christopher Etherton-Beer, School of Medicine and Pharmacology Royal Perth Hospital Unit, The University of Western Australia

School of Medicine and Pharmacology Royal Perth Hospital Unit, The University of Western Australia, Level 4, 50 Murray St, Perth, WA, 6000, Australia

Linda Klein, University of Newcastle, School of Medicine and Public Health

University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, 2308, Australia.

GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, 2304, Australia

Sarah Hilmer, Kolling Institute, University of Sydney, Royal North Shore Hospital

Kolling Institute, University of Sydney, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia

Summary of editorial team and board

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Published

2024-03-13

How to Cite

Tapley, A., Magin, P., van Driel, M., Bonevski, B., Holliday, E., Ball, J., Davey, A., Barnett, S., Gunter, C., Fogarty, J., Turner, R., Spike, N., Fitzgerald, K., Ralston, A., Etherton-Beer, C., Klein, L., & Hilmer, S. (2024). GP registrars’ deprescribing in older patients: a non-randomised controlled study.: GPs’ deprescribing. ealth ducation in ractice: ournal of esearch for rofessional earning, 7(1), 1–21. https://doi.org/10.33966/hepj.7.1.17351

Issue

Vol. 7 No. 1 (2024)

Section

Articles