Process evaluation of a pharmacist-led intervention aimed at
deprescribing and appropriate use of cardiometabolic medication among
people with type 2 diabetes
Abstract
Background: A quasi-experimental study investigated a pharmacist-led
intervention aimed at deprescribing among patients with type 2 diabetes
at risk of hypoglycaemia. Objective: To evaluate the process of
implementing the intervention in primary care in order to understand
variations in implementation and outcomes. Methods: Mixed-methods study
based on the Grant-framework, with 10 domains, including recruitment of
patients, delivery of the intervention, and response of pharmacists and
patients. Data collected were: administrative logs, semi-structured
observations of patient consultations (n=8), interviews with pharmacists
(n=16), and patient-reported experience measure (PREM) questionnaires
(n=66; response 73%). Results: Ninety patients from 14 pharmacies were
included. Although the selection of patients based on high
hypoglycaemia-risk was considered useful, pharmacists experienced
barriers to proposing deprescribing in patients with recent medication
changes, patients without current health problems or hypoglycaemic
events, and patients treated in secondary care. The consultation aid and
deprescribing tool provided were evaluated positively by the
pharmacists. The majority of patients were satisfied with the service
and information that the pharmacists provided. Conclusion: Pharmacists
and patients were positive about the intervention. Both groups valued
the consultation on deprescribing, supported by tools. To optimise the
effect, improvements can be made to patient selection and local
agreements on proactive deprescribing.