John Fellenor1, Nicky Britten2, Molly Courtenay3, Rupert A Payne4, Jose Valderas5, Rachel Denholm4, Polly Duncan4, Deborah McCahon4, Lynn Tatnell6, Richard Fitzgerald6, Krystal Warmoth2, David Gillespie7, Katrina Turner4, Margaret Watson8. 1. Department of Pharmacy & Pharmacology, University of Bath, Bath, England. 2. University of Exeter Medical School, University of Exeter, Exeter, England. 3. School of Healthcare Sciences, Cardiff University, Cardiff, Wales. 4. Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, England. 5. Health Services & Policy Research Group, Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, England. 6. Peninsula Public Involvement Group, University of Exeter, Exeter, England. 7. Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales. 8. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, Scotland. margaret.watson@strath.ac.uk.
Abstract
BACKGROUND: Up to 50% of medicines are not used as intended, resulting in poor health and economic outcomes. Medicines optimisation is 'a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines'. The purpose of this exercise was to co-produce a prioritised research agenda for medicines optimisation using a multi-stakeholder (patient, researcher, public and health professionals) approach. METHODS: A three-stage, multiple method process was used including: generation of preliminary research questions (Stage 1) using a modified Nominal Group Technique; electronic consultation and ranking with a wider multi-stakeholder group (Stage 2); a face-to-face, one-day consensus meeting involving representatives from all stakeholder groups (Stage 3). RESULTS: In total, 92 research questions were identified during Stages 1 and 2 and ranked in order of priority during stage 3. Questions were categorised into four areas: 'Patient Concerns' [e.g. is there a shared decision (with patients) about using each medicine?], 'Polypharmacy' [e.g. how to design health services to cope with the challenge of multiple medicines use?], 'Non-Medical Prescribing' [e.g. how can the contribution of non-medical prescribers be optimised in primary care?], and 'Deprescribing' [e.g. what support is needed by prescribers to deprescribe?]. A significant number of the 92 questions were generated by Patient and Public Involvement representatives, which demonstrates the importance of including this stakeholder group when identifying research priorities. CONCLUSIONS: A wide range of research questions was generated reflecting concerns which affect patients, practitioners, the health service, as well the ethical and philosophical aspects of the prescribing and deprescribing of medicines. These questions should be used to set future research agendas and funding commissions.
BACKGROUND: Up to 50% of medicines are not used as intended, resulting in poor health and economic outcomes. Medicines optimisation is 'a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines'. The purpose of this exercise was to co-produce a prioritised research agenda for medicines optimisation using a multi-stakeholder (patient, researcher, public and health professionals) approach. METHODS: A three-stage, multiple method process was used including: generation of preliminary research questions (Stage 1) using a modified Nominal Group Technique; electronic consultation and ranking with a wider multi-stakeholder group (Stage 2); a face-to-face, one-day consensus meeting involving representatives from all stakeholder groups (Stage 3). RESULTS: In total, 92 research questions were identified during Stages 1 and 2 and ranked in order of priority during stage 3. Questions were categorised into four areas: 'Patient Concerns' [e.g. is there a shared decision (with patients) about using each medicine?], 'Polypharmacy' [e.g. how to design health services to cope with the challenge of multiple medicines use?], 'Non-Medical Prescribing' [e.g. how can the contribution of non-medical prescribers be optimised in primary care?], and 'Deprescribing' [e.g. what support is needed by prescribers to deprescribe?]. A significant number of the 92 questions were generated by Patient and Public Involvement representatives, which demonstrates the importance of including this stakeholder group when identifying research priorities. CONCLUSIONS: A wide range of research questions was generated reflecting concerns which affect patients, practitioners, the health service, as well the ethical and philosophical aspects of the prescribing and deprescribing of medicines. These questions should be used to set future research agendas and funding commissions.
Authors: Jesse Jansen; Vasi Naganathan; Stacy M Carter; Andrew J McLachlan; Brooke Nickel; Les Irwig; Carissa Bonner; Jenny Doust; Jim Colvin; Aine Heaney; Robin Turner; Kirsten McCaffery Journal: BMJ Date: 2016-06-03
Authors: C Muth; J W Blom; S M Smith; K Johnell; A I Gonzalez-Gonzalez; T S Nguyen; M-S Brueckle; M Cesari; M E Tinetti; J M Valderas Journal: J Intern Med Date: 2018-12-10 Impact factor: 8.989