Preliminary feasibility assessment of a targeted, pharmacist-led intervention for older adults with polypharmacy: a mixed-methods study

Preliminary feasibility assessment of a targeted, pharmacist-led intervention for older adults with polypharmacy: a mixed-methods study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Preliminary feasibility assessment of a targeted, pharmacist-led intervention for older adults with polypharmacy: a mixed-methods study Lisheng Liu, Bernadette Brokenshire, Deborah Davies, Jeffrey Harrison This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3794044/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: Polypharmacy is associated with inappropriate prescribing and avoidable medicines-related harm. A novel pharmacist-led intervention has been developed to facilitate a targeted approach to identify and resolve inappropriate prescribing in older adults with polypharmacy. Aim: To conduct a preliminary feasibility assessment of the intervention in primary care, testing whether specific components of the intervention procedures and processes can be executed as intended. Method: In this mixed-methods study, patients were recruited from a New Zealand general practice clinic over a four-week recruitment period to receive the intervention. Process fidelity, patient, and clinician perspectives were collected. Quantitative data were analysed based on the study's progression criteria to determine whether a clinical trial of the full-scale intervention is warranted. Qualitative data were subjected to thematic analysis to identify facilitators and barriers to implementation. Results: The intervention met the study's progression criteria, including patient recruitment, retention, and adherence to the intervention procedures. However, several modifications were identified, including: 1) enhancing patient recruitment, 2) conducting a preliminary meeting between the patient and pharmacist, 3) supporting pharmacists in maintaining a patient-centred approach, 4) reviewing the choice of patient-reported outcome measure, 5) extending the eight-week follow-up period, 6) allocating more time for pharmacists to conduct the intervention. Conclusion: The study concluded that the intervention is feasible; however, additional development is required before progressing to a full-scale trial. This intervention holds the potential to provide an efficient approach to reducing medication-related harm and improving outcomes for older adults with polypharmacy. Trial registration number: ACTRN12621000268842 Date registered: 11/03/2021 Aged feasibility study geriatrics inappropriate prescribing pharmacist polypharmacy Figures Figure 1 Figure 2 Figure 3 IMPACT STATEMENTS More rigorously designed and evaluated interventions are needed to improve medication use for older adults with polypharmacy. This study aims to support patients and clinicians through a preliminary feasibility assessment of a novel pharmacist-led intervention designed to improve medication use for older adults with polypharmacy. INTRODUCTION Polypharmacy, the concurrent prescribing of multiple medications for patients, is an increasing healthcare challenge associated with inappropriate prescribing and avoidable medication-related harm [ 1 ]. Polypharmacy can be appropriate for patients with comorbidities when prescribing is based on up-to-date evidence [ 1 ]. However, problematic polypharmacy occurs if medication harm outweighs the benefits, if the medication is no longer indicated, or if adverse medication interactions and events occur [ 2 ]. In recognition of the risks associated with problematic polypharmacy, a necessary action from the New Zealand government's Pharmacy Action Plan is to "ensure models of care and contractual agreements provide equitable access to medicines management services targeted towards people receiving high-risk medicines or polypharmacy" [ 3 ]. Although progress has been made in developing interventions to improve medication use for older adults with polypharmacy, the quality of evidence remains poor due to inadequate reporting of intervention development and delivery [ 4 ]. To address the need for a rigorously developed and effective intervention, a novel pharmacist-led intervention was developed for primary healthcare. Its goal is to optimise medication use and reduce inappropriate prescribing for older adults with polypharmacy. As previously reported, a set of potentially inappropriate medication indicators was developed for the New Zealand healthcare setting [ 5 ]. These indicators served as the basis for the PolyScan information technology tool, which is used to identify older adults with polypharmacy based on their risk of inappropriate prescribing [ 6 ]. This intervention combines the PolyScan tool with pharmacist-led educational outreach and medication review. AIM In this study, the objective is to assess the preliminary feasibility of implementing the intervention within a general practice clinic. Specific components of the intervention procedures and processes were tested, and insights from patients and clinicians were gathered. The goal is to ascertain if a full-scale clinical trial of the intervention is warranted. ETHICS APPROVAL The study adhered to the Declaration of Helsinki principles and received approval from the New Zealand Health and Disability Ethics Committees (reference number: 20/STH/238 date: 12/01/2021) and the New Zealand public health agency, Te Whatu Ora Te Pae Hauora o Ruahine o Tararua (reference number: 2021.01.021 date: 20/04/2021). METHOD The design of this mixed-method study was informed by the Medical Research Council framework for developing and evaluating interventions [ 7 ]. Clinic, pharmacist, and patient recruitment Patients were recruited from a New Zealand general practice clinic over a four-week recruitment period from May to June 2021. In New Zealand, general practice clinics function as central healthcare hubs for a diverse population of older adults, providing medical services such as chronic disease management, routine check-ups, and prescription of medicines. The author (LL) met with the clinic to describe the study and obtain consent from the chief executive officer, who was asked to sign a consent form to participate. The pharmacist delivering the intervention was required to have the following qualifications and experience: 1) a current New Zealand pharmacist Annual Practicing Certificate, 2) a postgraduate university qualification in clinical pharmacy, and 3) experience practicing within general practice clinics. The PolyScan tool was used to screen the clinic's enrolled population for potentially eligible patients, who were then contacted by the clinic. For patients interested in participating, convenience sampling was utilised to include patients who were: 1) older adults with polypharmacy (aged 65 years or older, taking 11 or more medications) at risk of inappropriate prescribing, 2) enrolled in the participating clinic, 3) able to provide informed consent. Patients were excluded if they did not meet these conditions. Eligible patients were enrolled in the study by the pharmacist, who provided patients with a participant information sheet and asked them to sign a consent form before participating. The pharmacist-led intervention Figure 1 outlines the intervention procedures, including identifying patients, conducting educational outreach, medication review, and follow-up. (insert Fig. 1 here) In brief, the PolyScan tool is utilised to identify patients aged 65 years or older dispensed 11 or more medications daily at risk of inappropriate prescribing. Details regarding PolyScan's development is reported by Liu et al [ 6 ]. The pharmacist meets with the general practice clinicians to 1) discuss the outcomes generated by PolyScan, 2) provide education on problematic polypharmacy and rational medication use guidelines, 3) formulate a plan with clinicians to invite the identified at-risk patients for a medication review. The medication review process involves the pharmacist conducting a Medication Therapy Assessment (MTA) with patients. In New Zealand, MTA is a medication management service provided by clinically experienced pharmacists as part of their role within multidisciplinary healthcare teams. MTAs are "a systematic, patient-centred clinical assessment of all medicines currently taken by a patient" [ 8 ]. The pharmacist was allocated 30 minutes to meet with patients at the clinic or their homes to conduct the MTA. See Online Resource 1 for details of the MTA protocol. Finally, the pharmacist monitors the patient's medication response, including efficacy and safety, and follows up with the patient, their general practitioner, and other relevant members of the patient's healthcare team. The preliminary feasibility assessment Table 1 outlines the measures used to assess if specific intervention procedures and processes components could be delivered as intended. These measures were developed based on Thabane et al.'s process, resources, management, and scientific objectives [ 9 ]. The patient-reported outcome measure (PROM) as well as patient and clinician perspectives were also examined. (insert Table 1 here) Table 1 Preliminary feasibility assessment measures Objectives Assessment measures Data type Data collection and analysis procedures Data collection time-point Process: assessment of the feasibility of crucial processes for a clinical trial. Patient recruitment rate. Quantitative The number of patients who consented to participate: Versus the number of eligible patients (individuals aged 65 years and over, dispensed 11 or more medications daily, at risk of inappropriate prescribing) as identified by the PolyScan tool. One month after medication reviews were completed. Resources: assessment of time and resource issues. Inclusion and exclusion criteria for participation. Quantitative The number of referrals from the general practice clinic: Versus the number of referred patients eligible after screening by the inclusion and exclusion criteria. Versus the number of referred patients excluded after screening by the inclusion and exclusion criteria. Reasons for referred patients to be excluded after screening were assessed through study field notes. One month after medication reviews were completed. Success and refusal rates to participate. Quantitative The number of referred patients eligible: Versus the number of patients that agree to participate after being referred. Versus the number of patients that decline to participate after being referred. Reasons for patients declining to participate or barriers to participation were assessed through study field notes. One month after medication reviews were completed. Adherence of patients to study protocol. Quantitative The number of patients who did not complete the medication review and LMQ-3 questionnaire in its entirety. After each medication review was completed and at eight-week follow-up. Qualitative Reasons for non-adherence to study protocol were analysed through interview using thematic analysis. Length of time to complete intervention. Quantitative Time taken to complete the medication review. Time taken for patients to complete the LMQ-3 questionnaire. After each medication review was completed and at eight-week follow-up. The retention rate of patients. Quantitative The number of signed CF versus the number of patients requesting to withdraw from the study. Reasons for patient withdrawal were analysed through study field notes. At eight-week follow-up. Management: assessment of possible human or data management issues. Effectiveness of the PolyScan tool to collect and manage data. Quantitative Older adults with polypharmacy (aged 65 years and over, dispensed 11 or more long-term medications daily) at risk of inappropriate prescribing, as identified by the PolyScan tool, was compared against a manual review for 300 individuals aged 65 years or older. At intervention commencement. Patient understanding of the intervention. Qualitative Patients' clarification questions regarding the intervention were analysed through interview using thematic analysis. After each medication review was completed and at eight-week follow-up. Patient ability to complete the intervention and questionnaire. Qualitative Patient challenges with completing the intervention and the LMQ-3 questionnaire were analysed through interview using thematic analysis. After each medication review was completed and at eight-week follow-up. Appropriateness of the intervention location. Qualitative Patient issues with the space allocated for delivering the intervention were analysed through interview using thematic analysis. After each medication review was completed and at eight-week follow-up. Scientific: assessment of intervention safety, intervention effect and its variance. Acceptability of the intervention for clinicians. Quantitative ATCI-GP questionnaire scores by clinic GPs. Summative scores were calculated by adding scores from each questionnaire item and then dividing by the number of items making up the questionnaire to generate a score out of five. At eight-week follow-up. Intervention completion. Quantitative Number of pharmacist recommendations actioned by GPs using clinic practice management system records. At eight-week follow-up. Patient reported outcomes from the intervention. Quantitative LMQ-3 questionnaire scores by patients. Summative scores were calculated by adding together scores from each questionnaire item. After each medication review was completed and at eight-week follow-up. Patient satisfaction with the intervention. Qualitative Patient satisfaction with the intervention was analysed through interview using thematic analysis. After each medication review was completed and at eight-week follow-up. Abbreviations: ATCI-GP, Attitudes Towards Collaboration Instruments for General Practitioners questionnaire; CF, consent form; GP, general practitioner; LMQ-3, Living with Medicines Questionnaire version 3. Following each medication review, the author (LL) met with patient participants either at the clinic or their homes for a healthcare assessment. Fifteen minutes were allocated for patients to complete the Living with Medicines Questionnaire version 3 (LMQ-3) questionnaire, a PROM evaluating their health and medication use [ 10 ]. After eight weeks, the author met with patients again for a follow-up LMQ-3. The LMQ-3 consists of 41 self-administered items for patients. These items are rated on a five-point Likert scale, ranging from 'strongly agree' to 'strongly disagree,' and are grouped into eight different domains. The scores within each domain are combined to generate the total score, where higher scores indicate a greater medication burden [ 10 ]. Additionally, the LMQ-3 includes a visual analogue scale that allows patients to rate their overall perceived medication burden, ranging from 'no burden at all' to 'extremely burdensome' [ 10 ]. The LMQ-3 was selected as the PROM for this study because it has been used to evaluate other interventions for older patients with polypharmacy [ 11 ] and has been adapted for the New Zealand population [ 12 ]. To gather patient perspectives, the author (LL) conducted interviews with patient participants at the clinic or their homes following each medication review. Eight weeks after completing each medication review, a follow-up interview was conducted to gather the patients' perceptions of the intervention's outcomes. A semi-structured interview guide was developed based on Beyene et al.'s research [ 13 ]. See Online Resource 2 for the interview questions. To gather clinician perspectives, eight weeks after completing the medication reviews, the clinic's general practitioners were requested to anonymously complete the Attitudes Towards Collaboration Instruments for General Practitioners questionnaire [ 14 ]. The questionnaire consists of 13 self-administered items, scored using a five-point Likert scale. A higher score reflects more positive respondent attitudes towards pharmacist collaboration [ 14 ]. Data analysis Quantitative data were analysed to assess the study's progression criteria, which determined whether to proceed to a trial of the full-scale intervention (see Table 2 ). The progression criteria were developed based on the research of Rankin et al. and Avery et al. [ 15 , 16 ]. Qualitative data were analysed using thematic analysis to explore patient perspectives on the intervention. The thematic analysis followed the guidelines from Nowell et al. [ 17 ]. See Online Resource 3 for the protocol of the thematic analysis. (insert Table 2 here) Table 2 Study progression criteria Assessment measure Stop Amend Go Patient recruitment ≤ Four patients recruited in the four-week recruitment period. Five to seven patients recruited in the four-week recruitment period. ≥ Eight patients recruited in the four-week recruitment period. Retention rate of patients ≤ 49.0% of patients retained at eight-week follow-up. 50.0% – 79.0% of patients retained at eight-week follow-up. ≥ 80.0% of patients retained at eight-week follow-up. Adherence of patients to study protocol ≤ 49.0% of patients completed the medication review and LMQ-3 questionnaire in its entirety. 50.0–79.0% of patients completed the medication review and LMQ-3 in their entirety. ≥ 80.0% of patients completed the medication review and LMQ-3 in their entirety. Description Stop A full-scale trial is not feasible if one or more assessment measures meets the 'Stop' criteria. Amend A full-scale trial is feasible with modifications to the protocol if the assessment measures meet the 'Amend' criteria. Go A full-scale trial is feasible without modifying the protocol or amendments to the protocol if the assessment measures meet the 'Go' criteria. Abbreviations: LMQ-3, Living with Medicines Questionnaire version 3. RESULTS Quantitative results During the May-to-June 2021 recruitment period, the clinic's enrolled population was 2,259 patients, with 215 patients aged 65 years or older. After screening by PolyScan, 23 potentially eligible patients were identified and referred by the clinic to the study (see Fig. 2 ). Of the 23 patients, 15 met the inclusion criteria, while eight were excluded. Reasons for exclusion included patients subsequently unenrolling from the clinic (n = 4), patients being incapable of providing independent informed consent (n = 3), and patient death (n = 1). (insert Fig. 2 here) Of the 15 eligible referred patients who met the inclusion criteria, ten agreed to participate, while five were excluded. The reasons for exclusion included patients being unable to be contacted via telephone or email (n = 4) or declining due to other commitments (n = 1). One patient requested to withdraw from the study before the eight-week follow-up due to illness. The patient retention rate was, therefore, 90 percent. Regarding patient adherence, all patients completed the medication review and the initial LMQ-3 questionnaire. The median time to complete each medication review was 60 minutes. The median time to complete the LMQ-3 questionnaire was 12 minutes for the initial and follow-up appointments. Regarding the validity of PolyScan, as reported elsewhere by Liu et al., an assessment of the PolyScan tool identified nine individuals with polypharmacy who were prescribed potentially inappropriate medicines out of 300 older adults screened. Compared to a manual review, the tool achieved 100.0% sensitivity, specificity, and positive and negative predictive values [ 6 ]. Regarding the acceptability of the intervention for clinicians, all six practitioners from the clinic completed and returned the Attitudes Towards Collaboration Instruments for General Practitioners questionnaire. The summative scores ranged between four to five on a scale from one to five. See Online Resource 4 for results from the questionnaire. Regarding intervention completion, the median number of pharmacist recommendations was two per patient. At eight-week follow-up, the median number of recommendations implemented by general practitioners was one per patient. Patient medication burden was assessed using the LMQ-3 questionnaire. At the eight-week follow-up, the LMQ-3 score decreased for six patients, indicating an improvement in medication burden, and increased for three patients, indicating a worsening in medication burden. As for the LMQ-3 visual analogue scale, the score was reduced for five patients, indicating an improvement in medication burden, increased for two patients, indicating a worsening in medication burden, and remained unchanged for two patients. See Online Resource 5 for results from the questionnaire. Qualitative results Five primary themes emerged from the patient participant interviews: 1) satisfaction with the intervention, 2) appropriateness of the location for delivering the intervention, 3) understanding of the intervention and questionnaire, 4) ability to complete the intervention and questionnaire, and 5) adherence to the study protocol. Figure 3 provides a visual representation of the themes and sub-themes. (insert Fig. 3 here) Theme 1: Patient satisfaction with the intervention Subtheme 1: Patient relationship with the pharmacist Most patients developed a positive relationship with the pharmacist. They felt comfortable discussing their concerns, believed the pharmacist had a genuine interest in their well-being, and trusted the pharmacist to help make decisions about their medications and healthcare. One patient felt the pharmacist made assumptions without the necessary background understanding and that interpersonal trust could not be established. The patient suggested the pharmacist could have relayed an awareness of her health background to build trust and collaborate on treatment plans. Subtheme 2: Patient-centred communication with the pharmacist Most patients had positive experiences with the pharmacist's communication. They felt the pharmacist dedicated appropriate time to listen to their health concerns, understood their health needs, explained things clearly and understandably, and involved them in decisions about their medications. One patient expressed concerns that the pharmacist did not fully grasp her health needs. The patient felt the pharmacist used jargon and suggested that vulnerable individuals, such as those struggling to express themselves, might feel intimidated during the medication review. The patient proposed that to improve communication, the pharmacist should keep communication simple, slow down their speech, introduce less information initially, build more rapport, and ask patients why they are taking certain medications. Sub-theme 3: Patient confidence with the intervention Most patients were confident in the pharmacist's services, satisfied with the time taken for medication review, and believed that others would benefit from the intervention. Some patients felt that further engagement was necessary to establish an ongoing relationship with the pharmacist. The patient who previously expressed concerns suggested that an initial meeting to discuss the medication review process, the patient's health goals, and concerns would be beneficial. Sub-theme 4: Patient perceptions of outcomes at eight-week follow-up Most patients were pleased with the outcomes of the intervention. Approximately half of patients found the outcomes helpful, and most did not report any problems or adverse effects from the intervention. One patient did report adverse outcomes. The patient believed that while the pharmacist acted appropriately, the outcomes were not helpful, leading to adverse effects. The patient suggested that it was important for the pharmacist to acknowledge her unique health situation and that medications can have multiple indications, which should be considered in consultation with her doctor. Theme 2: Appropriateness of the location to deliver the intervention Sub-theme 1: Whether the medication review was conducted at the patient's home or the general practice clinic Most patients conducted the medication review at their homes, while one patient conducted the medication review at the clinic. Sub-theme 2: Patient experience with the space allocated for delivering the intervention Patients were satisfied with their medication review, whether it was provided at the clinic or home. They felt they could speak openly and privately about their medications in both environments. Most patients preferred face-to-face medication reviews over video or telephone calls. Theme 3: Patient understanding of the intervention Most patients felt they understood the intervention, which was introduced clearly. Some patients questioned the depth of the intervention and whether it might be perceived as solely about reducing medications. Patients agreed that it would be helpful to clarify what is included in the medication review and reassure people that the intervention is not about reducing medications but to ensure that medications are appropriate. Theme 4: Patient ability to complete the intervention and questionnaire Most patients did not find any aspects of the intervention to be difficult. When asked if other older adults might find any aspects challenging, patients commented that some people might need help with the terminology or feel hesitant about coming forward to receive the intervention. Patients agreed that it was essential to engage with individuals living alone or those who are more withdrawn. Patients recommended that the pharmacist initiate contact with people first to develop a working relationship. Theme 5: Adherence of patients to study protocol Most patients felt they could complete all the forms and the medication review. They did not find any questions confusing or inapplicable. DISCUSSION Managing patients with multiple comorbidities can be challenging due to the complexities of patient health and medication regimens, as well as the time constraints placed on clinicians. This study seeks to support clinicians through a preliminary feasibility assessment of an intervention designed to optimise medication use and reduce inappropriate prescribing for older adults with polypharmacy. The intervention procedures and processes met the study's process, resources, management, and scientific assessment measures. Patient recruitment, retention, and adherence to the intervention protocol met the progression criteria to proceed to an evaluation of the full-scale intervention. Additionally, patients found the intervention easy to understand, did not find the intervention challenging to complete, and were satisfied with the LMQ-3 questionnaire. Respondents of the Attitudes Towards Collaboration Instruments for General Practitioners questionnaire also reported positive attitudes of general practitioners toward collaboration with the pharmacist. Although the study met the preliminary feasibility assessment measures, it also identified valuable insights, which suggest the need for design modifications before pursuing a trial of the full-scale intervention. Effective patient recruitment will remain a crucial challenge to address. To enhance recruitment, the eligibility criteria should be expanded to include patients who cannot provide independent informed consent. Obtaining consent from a welfare guardian or enduring power of attorney ensures that patients unable to provide independent informed consent are not excluded from an intervention that could benefit their health. Furthermore, the inclusion criteria for this study was set for patients taking 11 or more medicines. Given the variation in numerical definitions of polypharmacy [ 18 ], to expand the pool of eligible patients, it could be appropriate to lower the medication count required for inclusion in a future trial. To support patient-pharmacist understanding and relationship building, a preliminary meeting should be arranged between the patient and the pharmacist to discuss the intervention and the patient's health. Additionally, it should be acknowledged that this intervention was not intended to and cannot replace opportunities to develop New Zealand indigenous Māori-led initiatives, such as Hikaka et al.'s medication intervention for Kaumatua (Māori elders) [ 19 ]. However, to ensure the quality of the intervention for Kaumatua, adopting Lacey et al.’s 'Hui Process' as a framework for the preliminary meeting and subsequent consultations could facilitate relationship building and ensure cultural safety [ 20 ]. Pharmacists delivering the intervention should receive training in a consultation skills programme to support a patient-centred approach during the medication review. A future training package for pharmacists could include Grimes and Barnett et al.'s patient-centred consultation skills programme to enhance communication, consultation, and health coaching skills [ 21 ]. Although patients expressed satisfaction with the LMQ-3, the questionnaire lacks some essential information required to function as an outcome measure in a future clinical trial. Any PROM selected for future use should provide data on aspects including sensitivity to change, minimal clinically important differences, and baseline score estimates. There is a lack of relevant data in the literature for the LMQ-3. The eight-week follow-up period should be reconsidered, as some pharmacist recommendations were not yet implemented by general practitioners who reviewed patients on a three-monthly prescription cycle. A longer follow-up period would allow general practitioners more time to consider the pharmacist's recommendations and identify beneficial or hazardous effects that may only become evident long after the intervention [ 22 , 23 ]. The time allocated for each medication review should be extended to 60 minutes. However, it is important to consider the implications of this increased time allocation for healthcare stakeholders and funders, as it may require additional resources and impact capacity. Nevertheless, it is worth noting that the medication review in this intervention was comprehensive and involved patients with complex medication regimens. Therefore, each review required more time than a standard consultation addressing a medical concern. Research has also established that investing time in a comprehensive medication review can lead to savings elsewhere, including improvements in the quality of medication processes and time savings for other clinicians [ 24 , 25 ]. The strength of this study was the careful and deliberate approach used to evaluate the intervention. The study employed clear measures to assess intervention procedures and processes, including quantitative and qualitative assessment measures and progression criteria. The study had several constraints. Firstly, all participants received the intervention to test specific procedures and processes. As a result, aspects of the full-scale intervention, such as the recruitment of the control group, randomisation process, and allocation concealment, were beyond the scope of this study. Secondly, the study had a small sample size and a short follow-up period. However, the study was not designed to identify statistically significant long-term findings. Thirdly, the pharmacist and clinic were not blinded to the intervention, which could have influenced clinician behaviour and reported outcomes. Lastly, despite using established, careful methods to analyse qualitative data, the interviewer's involvement in the intervention's development could have biased feedback. Employing an independent interviewer might have reduced bias, but it was not feasible due to budget and logistic constraints. There is recognition that pharmacist-led interventions in primary care can reduce medication-related adverse effects, medication errors, and hospital admissions [ 26 – 28 ]. Therefore, this intervention is suitable for evaluation by general practice clinics interested in integrating pharmacists into their teams. Further research could investigate the effectiveness of incorporating the intervention as part of a Cornerstone Continuous Quality Improvement module for New Zealand general practice clinics to demonstrate their efforts in enhancing health outcomes [ 29 ]. For researchers, this study serves as an example of an intervention developed based on the Medical Research Council's best practice framework for developing and evaluating interventions [ 7 ]. Despite the framework's availability since 2008, few interventions for older adults with polypharmacy have referenced it in their development [ 4 ]. Future research on similar interventions may benefit from adopting this framework to ensure that interventions are replicable, practical, and implementable across different settings. Lastly, this study underscores the importance of testing intervention procedures and processes for their feasibility. Despite the necessity of this stage, research suggests that feasibility evaluations are often overlooked [ 30 ]. Researchers may consider using the mixed-method approach employed in this study to design similar feasibility studies in future research. CONCLUSION The study's findings indicate that implementing the intervention into general practice is feasible; however, modifications are necessary before proceeding to a full-scale clinical trial. The next phase of this research programme will focus on developing a cluster-randomised controlled trial for the full-scale intervention. This trial will incorporate the changes identified in this study and provide details such as study duration, baseline data collection, definitive outcome measures, sample size, randomisation, blinding, and statistical methods. Additionally, it will include economic and process evaluations to investigate the cost-effectiveness of the intervention and identify barriers to implementing pharmacist recommendations. Declarations Acknowledgements: The authors would like to thank Dr Bruce Stewart for his help in planning this study and feedback on the manuscript, Mr Adam Holloway for his help in producing the Figure 1 infographic, and the general practice clinic and patients who participated in this study for their time and contribution. Funding: The authors declare that no funds or grants were received during the preparation of this manuscript. Conflicts of interest: The authors declare no relevant financial or non-financial interests for this study. Ethics approval: The study adhered to the Declaration of Helsinki principles and received approval from the New Zealand Health and Disability Ethics Committees (reference number: 20/STH/238 date: 12/01/2021) and the New Zealand public health agency, Te Whatu Ora Te Pae Hauora o Ruahine o Tararua (reference number: 2021.01.021 date: 20/04/2021). Consent to participate/publish: All participants provided written informed consent to participate in the study. All participants provided informed consent to the publication of the study, with the understanding that it will not contain information that could identify them individually. Data availability: The data generated during this study is available in Figshare, https://doi.org/10.17608/k6.auckland.24871563.v1 Author contributions: Conceptualisation: Lisheng Liu, Jeff Harrison, Bernadette Brokenshire, Deborah Davies; Methodology: Lisheng Liu, Jeff Harrison; Formal analysis and investigation: Lisheng Liu, Jeff Harrison; Writing – original draft preparation: Lisheng Liu; Writing – review and editing: Lisheng Liu, Jeff Harrison, Bernadette Brokenshire, Deborah Davies; Supervision: Jeff Harrison. References Durden M, Avery T, Payne R. Polypharmacy and medicines optimisation. United Kingdom: The King's Fund; 2013. ISBN: 978 1 909029 18 7 Scott I, Anderson K, Freeman C, et al. 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A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. Lancet. 2012;379:1310-1319. Royal S, Smeation L, Avery A, et al. Interventions in primary care to reduce medication related adverse events and hospital admissions: systematic review and meta-analysis. Qual Saf Health Care. 2006;15(1):23-31. Romanelli R, Leahy A, Jukes T, et al. Pharmacist-led medication management program within a patient-centred medical home. Am J Health Syst Pharm. 2015;72(6):453-459. The Royal New Zealand College of General Practitioners. Continuous Quality Improvement module. In: Quality Programmes. The Royal New Zealand College of General Practitioners. 2020. https://www.rnzcgp.org.nz/Quality/Cornerstone/Continuous_Quality_Improvement_module/Quality/CQI_module/CQI_introduction.aspx. Accessed 05.12.2021. Eldridge S, Ashby D, Feder G, et al. Lessons for cluster randomised trials in the twenty-first century: a systematic review of trial in primary care. Clin Trials. 2004;1:80-90. Supplementary Files SupplementaryInformation1.pdf SUPPLEMENTARY MATERIAL Online Resource 1 Pharmacist protocol for conducting Medication Therapy Assessments SupplementaryInformation2.pdf Online Resource 2 Interview guide SupplementaryInformation3.pdf Online Resource 3 Protocol for conducting thematic analysis SupplementaryInformation4.pdf Online Resource 4 Results from Attitudes Toward Collaboration Instrument for GPs questionnaire SupplementaryInformation5.pdf Online Resource 5 Participant LMQ-3 results at initial appointment and at eight-week follow-up Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Minor revisions 14 Feb, 2024 Reviewers agreed at journal 27 Dec, 2023 Reviewers invited by journal 22 Dec, 2023 Editor assigned by journal 21 Dec, 2023 First submitted to journal 21 Dec, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3794044","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":262548900,"identity":"1ec7af3b-bd6d-4751-85c3-73ad027205e6","order_by":0,"name":"Lisheng Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIie3PsUoDMRjA8S8E0uXU9RNs7xVOMurDJBS8xYrgesMHB3EpdT0nX+F8g8jBufgAJ3bwKHRysIu4WE2vgyCm6uaQPyFkyI98AQiF/mHbPUZssXwfuDOHRwBGq7UpwRlxFFx2RP2OuC0SXNMn+SHBuUGMRHpRDGeJyqb98iEneM3gJPZgN5jBU4xGRXMklarnspzeEBvXcOZ7ryOY4IiaY26VqHTZuCG3CHTu/77BSCVp3JHlmrA3R8xGYpVKHFHarAlfvTL2k/xgl+z+9d1cJnpSyUtHqr0adeEhO73z9n5BNh7cDmf4/FL1J03atk/Zob7yfP/7LAD+5X4oFAqFvvQBhllbkA9NizsAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-0280-4793","institution":"The University of Auckland Faculty of Medical and Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Lisheng","middleName":"","lastName":"Liu","suffix":""},{"id":262548901,"identity":"5afc3840-e165-4c40-80d7-3832e449dba9","order_by":1,"name":"Bernadette Brokenshire","email":"","orcid":"","institution":"Te Whatu Ora Health New Zealand MidCentral: Te Pae Hauora o Ruahine o Tararua MidCentral","correspondingAuthor":false,"prefix":"","firstName":"Bernadette","middleName":"","lastName":"Brokenshire","suffix":""},{"id":262548902,"identity":"9f31b20c-e03e-49ed-93a1-22720bbef82d","order_by":2,"name":"Deborah Davies","email":"","orcid":"","institution":"Te Whatu Ora Health NZ MidCentral: Te Pae Hauora o Ruahine o Tararua MidCentral","correspondingAuthor":false,"prefix":"","firstName":"Deborah","middleName":"","lastName":"Davies","suffix":""},{"id":262548903,"identity":"50307b7e-c4d7-4f1c-81a7-2615c39ea674","order_by":3,"name":"Jeffrey Harrison","email":"","orcid":"https://orcid.org/0000-0001-8478-7469","institution":"The University of Auckland Faculty of Medical and Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Jeffrey","middleName":"","lastName":"Harrison","suffix":""}],"badges":[],"createdAt":"2023-12-22 22:38:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3794044/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3794044/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49146471,"identity":"10b24e6f-03e8-4f9a-9c46-dad842934b48","added_by":"auto","created_at":"2024-01-03 20:22:12","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":95722,"visible":true,"origin":"","legend":"\u003cp\u003eProcedures of the pharmacist-led intervention\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3794044/v1/6d5e3a031f765df7434d5efb.jpg"},{"id":49146470,"identity":"462cbd47-5b80-4829-adad-c31ac82b5414","added_by":"auto","created_at":"2024-01-03 20:22:12","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":75842,"visible":true,"origin":"","legend":"\u003cp\u003eSummary flowchart of patient recruitment\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3794044/v1/1fcceafe626ebaf490942f2f.jpg"},{"id":49146664,"identity":"7002be04-a456-40a3-b384-09dee1ccf042","added_by":"auto","created_at":"2024-01-03 20:30:12","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":66368,"visible":true,"origin":"","legend":"\u003cp\u003eConcept map of themes and sub-themes\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3794044/v1/b9c7106f5ca4001683bc0b54.jpg"},{"id":49147240,"identity":"fba2b959-228a-46b9-9a5e-7798c79c2f77","added_by":"auto","created_at":"2024-01-03 20:38:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":688787,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3794044/v1/b203651f-6cd5-4203-985e-bdc8b2efab2c.pdf"},{"id":49146666,"identity":"eeb2285f-a275-4e99-ae48-63a4f2bb0d25","added_by":"auto","created_at":"2024-01-03 20:30:12","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":274120,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSUPPLEMENTARY MATERIAL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOnline Resource 1 \u003c/strong\u003ePharmacist protocol for conducting Medication Therapy Assessments\u003c/p\u003e","description":"","filename":"SupplementaryInformation1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3794044/v1/b5c8f7eed11e7404e3eb9866.pdf"},{"id":49146474,"identity":"ece51de5-5493-4cca-b2e8-5ac28fd0d233","added_by":"auto","created_at":"2024-01-03 20:22:12","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":266545,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOnline Resource 2 \u003c/strong\u003eInterview guide\u003c/p\u003e","description":"","filename":"SupplementaryInformation2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3794044/v1/eb94d93f754044536dbd1a84.pdf"},{"id":49146476,"identity":"61b5bafc-7b5a-443b-a34a-7527276b24ec","added_by":"auto","created_at":"2024-01-03 20:22:12","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":263390,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOnline Resource 3 \u003c/strong\u003eProtocol for conducting thematic analysis\u003c/p\u003e","description":"","filename":"SupplementaryInformation3.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3794044/v1/0e310db0e298cec8607d1935.pdf"},{"id":49146665,"identity":"7ba3faa4-3b38-4e9a-9443-4c5cf12edb00","added_by":"auto","created_at":"2024-01-03 20:30:12","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":134711,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOnline Resource 4 \u003c/strong\u003eResults from Attitudes Toward Collaboration Instrument for GPs questionnaire\u003c/p\u003e","description":"","filename":"SupplementaryInformation4.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3794044/v1/7d854d0ec5fa42f2b0c1c3a7.pdf"},{"id":49146475,"identity":"49c3f299-0651-4a00-a244-8db2ff0c3941","added_by":"auto","created_at":"2024-01-03 20:22:12","extension":"pdf","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":323349,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOnline Resource 5 \u003c/strong\u003eParticipant LMQ-3 results at initial appointment and at eight-week follow-up\u003c/p\u003e","description":"","filename":"SupplementaryInformation5.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3794044/v1/d932a5c58fa9e0de8945678d.pdf"}],"financialInterests":"","formattedTitle":"Preliminary feasibility assessment of a targeted, pharmacist-led intervention for older adults with polypharmacy: a mixed-methods study","fulltext":[{"header":"IMPACT STATEMENTS","content":"\u003cul\u003e\n \u003cli\u003eMore rigorously designed and evaluated interventions are needed to improve medication use for older adults with polypharmacy.\u003c/li\u003e\n \u003cli\u003eThis study aims to support patients and clinicians through a preliminary feasibility assessment of a novel pharmacist-led intervention designed to improve medication use for older adults with polypharmacy.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003ePolypharmacy, the concurrent prescribing of multiple medications for patients, is an increasing healthcare challenge associated with inappropriate prescribing and avoidable medication-related harm [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Polypharmacy can be appropriate for patients with comorbidities when prescribing is based on up-to-date evidence [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, problematic polypharmacy occurs if medication harm outweighs the benefits, if the medication is no longer indicated, or if adverse medication interactions and events occur [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recognition of the risks associated with problematic polypharmacy, a necessary action from the New Zealand government's Pharmacy Action Plan is to \"ensure models of care and contractual agreements provide equitable access to medicines management services targeted towards people receiving high-risk medicines or polypharmacy\" [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough progress has been made in developing interventions to improve medication use for older adults with polypharmacy, the quality of evidence remains poor due to inadequate reporting of intervention development and delivery [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo address the need for a rigorously developed and effective intervention, a novel pharmacist-led intervention was developed for primary healthcare. Its goal is to optimise medication use and reduce inappropriate prescribing for older adults with polypharmacy. As previously reported, a set of potentially inappropriate medication indicators was developed for the New Zealand healthcare setting [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These indicators served as the basis for the PolyScan information technology tool, which is used to identify older adults with polypharmacy based on their risk of inappropriate prescribing [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This intervention combines the PolyScan tool with pharmacist-led educational outreach and medication review.\u003c/p\u003e\n\u003ch3\u003eAIM\u003c/h3\u003e\n\u003cp\u003eIn this study, the objective is to assess the preliminary feasibility of implementing the intervention within a general practice clinic. Specific components of the intervention procedures and processes were tested, and insights from patients and clinicians were gathered. The goal is to ascertain if a full-scale clinical trial of the intervention is warranted.\u003c/p\u003e\n\u003ch3\u003eETHICS APPROVAL\u003c/h3\u003e\n\u003cp\u003e The study adhered to the Declaration of Helsinki principles and received approval from the New Zealand Health and Disability Ethics Committees (reference number: 20/STH/238 date: 12/01/2021) and the New Zealand public health agency, Te Whatu Ora Te Pae Hauora o Ruahine o Tararua (reference number: 2021.01.021 date: 20/04/2021).\u003c/p\u003e"},{"header":"METHOD","content":"\u003cp\u003eThe design of this mixed-method study was informed by the Medical Research Council framework for developing and evaluating interventions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eClinic, pharmacist, and patient recruitment\u003c/h2\u003e \u003cp\u003ePatients were recruited from a New Zealand general practice clinic over a four-week recruitment period from May to June 2021. In New Zealand, general practice clinics function as central healthcare hubs for a diverse population of older adults, providing medical services such as chronic disease management, routine check-ups, and prescription of medicines.\u003c/p\u003e \u003cp\u003eThe author (LL) met with the clinic to describe the study and obtain consent from the chief executive officer, who was asked to sign a consent form to participate.\u003c/p\u003e \u003cp\u003eThe pharmacist delivering the intervention was required to have the following qualifications and experience: 1) a current New Zealand pharmacist Annual Practicing Certificate, 2) a postgraduate university qualification in clinical pharmacy, and 3) experience practicing within general practice clinics.\u003c/p\u003e \u003cp\u003eThe PolyScan tool was used to screen the clinic's enrolled population for potentially eligible patients, who were then contacted by the clinic. For patients interested in participating, convenience sampling was utilised to include patients who were: 1) older adults with polypharmacy (aged 65 years or older, taking 11 or more medications) at risk of inappropriate prescribing, 2) enrolled in the participating clinic, 3) able to provide informed consent. Patients were excluded if they did not meet these conditions. Eligible patients were enrolled in the study by the pharmacist, who provided patients with a participant information sheet and asked them to sign a consent form before participating.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eThe pharmacist-led intervention\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e outlines the intervention procedures, including identifying patients, conducting educational outreach, medication review, and follow-up. \u003cem\u003e(insert\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003ehere)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn brief, the PolyScan tool is utilised to identify patients aged 65 years or older dispensed 11 or more medications daily at risk of inappropriate prescribing. Details regarding PolyScan's development is reported by Liu et al [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e The pharmacist meets with the general practice clinicians to 1) discuss the outcomes generated by PolyScan, 2) provide education on problematic polypharmacy and rational medication use guidelines, 3) formulate a plan with clinicians to invite the identified at-risk patients for a medication review.\u003c/p\u003e \u003cp\u003eThe medication review process involves the pharmacist conducting a Medication Therapy Assessment (MTA) with patients. In New Zealand, MTA is a medication management service provided by clinically experienced pharmacists as part of their role within multidisciplinary healthcare teams. MTAs are \"a systematic, patient-centred clinical assessment of all medicines currently taken by a patient\" [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The pharmacist was allocated 30 minutes to meet with patients at the clinic or their homes to conduct the MTA. See Online Resource 1 for details of the MTA protocol.\u003c/p\u003e \u003cp\u003eFinally, the pharmacist monitors the patient's medication response, including efficacy and safety, and follows up with the patient, their general practitioner, and other relevant members of the patient's healthcare team.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eThe preliminary feasibility assessment\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e outlines the measures used to assess if specific intervention procedures and processes components could be delivered as intended. These measures were developed based on Thabane et al.'s process, resources, management, and scientific objectives [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The patient-reported outcome measure (PROM) as well as patient and clinician perspectives were also examined. \u003cem\u003e(insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003ehere)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePreliminary feasibility assessment measures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObjectives\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssessment measures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eData type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eData collection and analysis procedures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eData collection time-point\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcess: assessment of the feasibility of crucial processes for a clinical trial.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient recruitment rate.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe number of patients who consented to participate:\u003c/p\u003e \u003cp\u003eVersus the number of eligible patients (individuals aged 65 years and over, dispensed 11 or more medications daily, at risk of inappropriate prescribing) as identified by the PolyScan tool.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne month after medication reviews were completed.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eResources: assessment of time and resource issues.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInclusion and exclusion criteria for participation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe number of referrals from the general practice clinic:\u003c/p\u003e \u003cp\u003eVersus the number of referred patients eligible after screening by the inclusion and exclusion criteria.\u003c/p\u003e \u003cp\u003eVersus the number of referred patients excluded after screening by the inclusion and exclusion criteria.\u003c/p\u003e \u003cp\u003eReasons for referred patients to be excluded after screening were assessed through study field notes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne month after medication reviews were completed.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuccess and refusal rates to participate.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe number of referred patients eligible:\u003c/p\u003e \u003cp\u003eVersus the number of patients that agree to participate after being referred.\u003c/p\u003e \u003cp\u003eVersus the number of patients that decline to participate after being referred.\u003c/p\u003e \u003cp\u003eReasons for patients declining to participate or barriers to participation were assessed through study field notes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne month after medication reviews were completed.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdherence of patients to study protocol.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe number of patients who did not complete the medication review and LMQ-3 questionnaire in its entirety.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAfter each medication review was completed and at eight-week follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReasons for non-adherence to study protocol were analysed through interview using thematic analysis.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLength of time to complete intervention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTime taken to complete the medication review.\u003c/p\u003e \u003cp\u003eTime taken for patients to complete the LMQ-3 questionnaire.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAfter each medication review was completed and at eight-week follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe retention rate of patients.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe number of signed CF versus the number of patients requesting to withdraw from the study.\u003c/p\u003e \u003cp\u003eReasons for patient withdrawal were analysed through study field notes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAt eight-week follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eManagement: assessment of possible human or data management issues.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEffectiveness of the PolyScan tool to collect and manage data.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOlder adults with polypharmacy (aged 65 years and over, dispensed 11 or more long-term medications daily) at risk of inappropriate prescribing, as identified by the PolyScan tool, was compared against a manual review for 300 individuals aged 65 years or older.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAt intervention commencement.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient understanding of the intervention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients' clarification questions regarding the intervention were analysed through interview using thematic analysis.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAfter each medication review was completed and at eight-week follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient ability to complete the intervention and questionnaire.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatient challenges with completing the intervention and the LMQ-3 questionnaire were analysed through interview using thematic analysis.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAfter each medication review was completed and at eight-week follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAppropriateness of the intervention location.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatient issues with the space allocated for delivering the intervention were analysed through interview using thematic analysis.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAfter each medication review was completed and at eight-week follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eScientific: assessment of intervention safety, intervention effect and its variance.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcceptability of the intervention for clinicians.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eATCI-GP questionnaire scores by clinic GPs. Summative scores were calculated by adding scores from each questionnaire item and then dividing by the number of items making up the questionnaire to generate a score out of five.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAt eight-week follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention completion.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber of pharmacist recommendations actioned by GPs using clinic practice management system records.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAt eight-week follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient reported outcomes from the intervention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLMQ-3 questionnaire scores by patients. Summative scores were calculated by adding together scores from each questionnaire item.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAfter each medication review was completed and at eight-week follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient satisfaction with the intervention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatient satisfaction with the intervention was analysed through interview using thematic analysis.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAfter each medication review was completed and at eight-week follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: ATCI-GP, Attitudes Towards Collaboration Instruments for General Practitioners questionnaire; CF, consent form; GP, general practitioner; LMQ-3, Living with Medicines Questionnaire version 3.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFollowing each medication review, the author (LL) met with patient participants either at the clinic or their homes for a healthcare assessment. Fifteen minutes were allocated for patients to complete the Living with Medicines Questionnaire version 3 (LMQ-3) questionnaire, a PROM evaluating their health and medication use [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. After eight weeks, the author met with patients again for a follow-up LMQ-3.\u003c/p\u003e \u003cp\u003eThe LMQ-3 consists of 41 self-administered items for patients. These items are rated on a five-point Likert scale, ranging from 'strongly agree' to 'strongly disagree,' and are grouped into eight different domains. The scores within each domain are combined to generate the total score, where higher scores indicate a greater medication burden [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Additionally, the LMQ-3 includes a visual analogue scale that allows patients to rate their overall perceived medication burden, ranging from 'no burden at all' to 'extremely burdensome' [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The LMQ-3 was selected as the PROM for this study because it has been used to evaluate other interventions for older patients with polypharmacy [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and has been adapted for the New Zealand population [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo gather patient perspectives, the author (LL) conducted interviews with patient participants at the clinic or their homes following each medication review. Eight weeks after completing each medication review, a follow-up interview was conducted to gather the patients' perceptions of the intervention's outcomes. A semi-structured interview guide was developed based on Beyene et al.'s research [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. See Online Resource 2 for the interview questions.\u003c/p\u003e \u003cp\u003eTo gather clinician perspectives, eight weeks after completing the medication reviews, the clinic's general practitioners were requested to anonymously complete the Attitudes Towards Collaboration Instruments for General Practitioners questionnaire [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The questionnaire consists of 13 self-administered items, scored using a five-point Likert scale. A higher score reflects more positive respondent attitudes towards pharmacist collaboration [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eQuantitative data were analysed to assess the study's progression criteria, which determined whether to proceed to a trial of the full-scale intervention (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The progression criteria were developed based on the research of Rankin et al. and Avery et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Qualitative data were analysed using thematic analysis to explore patient perspectives on the intervention. The thematic analysis followed the guidelines from Nowell et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. See Online Resource 3 for the protocol of the thematic analysis. \u003cem\u003e(insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cem\u003ehere)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudy progression criteria\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssessment measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStop\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmend\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGo\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient recruitment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le; Four patients recruited in the four-week recruitment period.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFive to seven patients recruited in the four-week recruitment period.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge; Eight patients recruited in the four-week recruitment period.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRetention rate of patients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;49.0% of patients retained at eight-week follow-up.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0% \u0026ndash; 79.0% of patients retained at eight-week follow-up.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;80.0% of patients retained at eight-week follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdherence of patients to study protocol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;49.0% of patients completed the medication review and LMQ-3 questionnaire in its entirety.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0\u0026ndash;79.0% of patients completed the medication review and LMQ-3 in their entirety.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;80.0% of patients completed the medication review and LMQ-3 in their entirety.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDescription\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStop\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eA full-scale trial is not feasible if one or more assessment measures meets the 'Stop' criteria.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAmend\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eA full-scale trial is feasible with modifications to the protocol if the assessment measures meet the 'Amend' criteria.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eA full-scale trial is feasible without modifying the protocol or amendments to the protocol if the assessment measures meet the 'Go' criteria.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAbbreviations: LMQ-3, Living with Medicines Questionnaire version 3.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative results\u003c/h2\u003e \u003cp\u003eDuring the May-to-June 2021 recruitment period, the clinic's enrolled population was 2,259 patients, with 215 patients aged 65 years or older. After screening by PolyScan, 23 potentially eligible patients were identified and referred by the clinic to the study (see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Of the 23 patients, 15 met the inclusion criteria, while eight were excluded. Reasons for exclusion included patients subsequently unenrolling from the clinic (n\u0026thinsp;=\u0026thinsp;4), patients being incapable of providing independent informed consent (n\u0026thinsp;=\u0026thinsp;3), and patient death (n\u0026thinsp;=\u0026thinsp;1). \u003cem\u003e(insert\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cem\u003ehere)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOf the 15 eligible referred patients who met the inclusion criteria, ten agreed to participate, while five were excluded. The reasons for exclusion included patients being unable to be contacted via telephone or email (n\u0026thinsp;=\u0026thinsp;4) or declining due to other commitments (n\u0026thinsp;=\u0026thinsp;1). One patient requested to withdraw from the study before the eight-week follow-up due to illness. The patient retention rate was, therefore, 90 percent.\u003c/p\u003e \u003cp\u003eRegarding patient adherence, all patients completed the medication review and the initial LMQ-3 questionnaire. The median time to complete each medication review was 60 minutes. The median time to complete the LMQ-3 questionnaire was 12 minutes for the initial and follow-up appointments.\u003c/p\u003e \u003cp\u003eRegarding the validity of PolyScan, as reported elsewhere by Liu et al., an assessment of the PolyScan tool identified nine individuals with polypharmacy who were prescribed potentially inappropriate medicines out of 300 older adults screened. Compared to a manual review, the tool achieved 100.0% sensitivity, specificity, and positive and negative predictive values [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding the acceptability of the intervention for clinicians, all six practitioners from the clinic completed and returned the Attitudes Towards Collaboration Instruments for General Practitioners questionnaire. The summative scores ranged between four to five on a scale from one to five. See Online Resource 4 for results from the questionnaire.\u003c/p\u003e \u003cp\u003eRegarding intervention completion, the median number of pharmacist recommendations was two per patient. At eight-week follow-up, the median number of recommendations implemented by general practitioners was one per patient.\u003c/p\u003e \u003cp\u003ePatient medication burden was assessed using the LMQ-3 questionnaire. At the eight-week follow-up, the LMQ-3 score decreased for six patients, indicating an improvement in medication burden, and increased for three patients, indicating a worsening in medication burden. As for the LMQ-3 visual analogue scale, the score was reduced for five patients, indicating an improvement in medication burden, increased for two patients, indicating a worsening in medication burden, and remained unchanged for two patients. See Online Resource 5 for results from the questionnaire.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eQualitative results\u003c/h2\u003e \u003cp\u003eFive primary themes emerged from the patient participant interviews: 1) satisfaction with the intervention, 2) appropriateness of the location for delivering the intervention, 3) understanding of the intervention and questionnaire, 4) ability to complete the intervention and questionnaire, and 5) adherence to the study protocol. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e provides a visual representation of the themes and sub-themes. \u003cem\u003e(insert\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cem\u003ehere)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Patient satisfaction with the intervention\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eSubtheme 1: Patient relationship with the pharmacist\u003c/h2\u003e \u003cp\u003eMost patients developed a positive relationship with the pharmacist. They felt comfortable discussing their concerns, believed the pharmacist had a genuine interest in their well-being, and trusted the pharmacist to help make decisions about their medications and healthcare.\u003c/p\u003e \u003cp\u003eOne patient felt the pharmacist made assumptions without the necessary background understanding and that interpersonal trust could not be established. The patient suggested the pharmacist could have relayed an awareness of her health background to build trust and collaborate on treatment plans.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 2: Patient-centred communication with the pharmacist\u003c/h2\u003e \u003cp\u003eMost patients had positive experiences with the pharmacist's communication. They felt the pharmacist dedicated appropriate time to listen to their health concerns, understood their health needs, explained things clearly and understandably, and involved them in decisions about their medications.\u003c/p\u003e \u003cp\u003eOne patient expressed concerns that the pharmacist did not fully grasp her health needs. The patient felt the pharmacist used jargon and suggested that vulnerable individuals, such as those struggling to express themselves, might feel intimidated during the medication review. The patient proposed that to improve communication, the pharmacist should keep communication simple, slow down their speech, introduce less information initially, build more rapport, and ask patients why they are taking certain medications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 3: Patient confidence with the intervention\u003c/h2\u003e \u003cp\u003eMost patients were confident in the pharmacist's services, satisfied with the time taken for medication review, and believed that others would benefit from the intervention.\u003c/p\u003e \u003cp\u003eSome patients felt that further engagement was necessary to establish an ongoing relationship with the pharmacist. The patient who previously expressed concerns suggested that an initial meeting to discuss the medication review process, the patient's health goals, and concerns would be beneficial.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 4: Patient perceptions of outcomes at eight-week follow-up\u003c/h2\u003e \u003cp\u003eMost patients were pleased with the outcomes of the intervention. Approximately half of patients found the outcomes helpful, and most did not report any problems or adverse effects from the intervention.\u003c/p\u003e \u003cp\u003eOne patient did report adverse outcomes. The patient believed that while the pharmacist acted appropriately, the outcomes were not helpful, leading to adverse effects. The patient suggested that it was important for the pharmacist to acknowledge her unique health situation and that medications can have multiple indications, which should be considered in consultation with her doctor.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Appropriateness of the location to deliver the intervention\u003c/h2\u003e \u003cp\u003e \u003cem\u003eSub-theme 1: Whether the medication review was conducted at the patient's home or the general practice clinic\u003c/em\u003e \u003c/p\u003e \u003cp\u003eMost patients conducted the medication review at their homes, while one patient conducted the medication review at the clinic.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 2: Patient experience with the space allocated for delivering the intervention\u003c/h2\u003e \u003cp\u003ePatients were satisfied with their medication review, whether it was provided at the clinic or home. They felt they could speak openly and privately about their medications in both environments. Most patients preferred face-to-face medication reviews over video or telephone calls.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Patient understanding of the intervention\u003c/h2\u003e \u003cp\u003eMost patients felt they understood the intervention, which was introduced clearly.\u003c/p\u003e \u003cp\u003eSome patients questioned the depth of the intervention and whether it might be perceived as solely about reducing medications. Patients agreed that it would be helpful to clarify what is included in the medication review and reassure people that the intervention is not about reducing medications but to ensure that medications are appropriate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: Patient ability to complete the intervention and questionnaire\u003c/h2\u003e \u003cp\u003eMost patients did not find any aspects of the intervention to be difficult.\u003c/p\u003e \u003cp\u003eWhen asked if other older adults might find any aspects challenging, patients commented that some people might need help with the terminology or feel hesitant about coming forward to receive the intervention. Patients agreed that it was essential to engage with individuals living alone or those who are more withdrawn. Patients recommended that the pharmacist initiate contact with people first to develop a working relationship.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eTheme 5: Adherence of patients to study protocol\u003c/h2\u003e \u003cp\u003eMost patients felt they could complete all the forms and the medication review. They did not find any questions confusing or inapplicable.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eManaging patients with multiple comorbidities can be challenging due to the complexities of patient health and medication regimens, as well as the time constraints placed on clinicians. This study seeks to support clinicians through a preliminary feasibility assessment of an intervention designed to optimise medication use and reduce inappropriate prescribing for older adults with polypharmacy.\u003c/p\u003e \u003cp\u003eThe intervention procedures and processes met the study's process, resources, management, and scientific assessment measures. Patient recruitment, retention, and adherence to the intervention protocol met the progression criteria to proceed to an evaluation of the full-scale intervention. Additionally, patients found the intervention easy to understand, did not find the intervention challenging to complete, and were satisfied with the LMQ-3 questionnaire. Respondents of the Attitudes Towards Collaboration Instruments for General Practitioners questionnaire also reported positive attitudes of general practitioners toward collaboration with the pharmacist.\u003c/p\u003e \u003cp\u003eAlthough the study met the preliminary feasibility assessment measures, it also identified valuable insights, which suggest the need for design modifications before pursuing a trial of the full-scale intervention.\u003c/p\u003e \u003cp\u003eEffective patient recruitment will remain a crucial challenge to address. To enhance recruitment, the eligibility criteria should be expanded to include patients who cannot provide independent informed consent. Obtaining consent from a welfare guardian or enduring power of attorney ensures that patients unable to provide independent informed consent are not excluded from an intervention that could benefit their health. Furthermore, the inclusion criteria for this study was set for patients taking 11 or more medicines. Given the variation in numerical definitions of polypharmacy [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], to expand the pool of eligible patients, it could be appropriate to lower the medication count required for inclusion in a future trial.\u003c/p\u003e \u003cp\u003eTo support patient-pharmacist understanding and relationship building, a preliminary meeting should be arranged between the patient and the pharmacist to discuss the intervention and the patient's health. Additionally, it should be acknowledged that this intervention was not intended to and cannot replace opportunities to develop New Zealand indigenous Māori-led initiatives, such as Hikaka et al.'s medication intervention for Kaumatua (Māori elders) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, to ensure the quality of the intervention for Kaumatua, adopting Lacey et al.\u0026rsquo;s 'Hui Process' as a framework for the preliminary meeting and subsequent consultations could facilitate relationship building and ensure cultural safety [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePharmacists delivering the intervention should receive training in a consultation skills programme to support a patient-centred approach during the medication review. A future training package for pharmacists could include Grimes and Barnett et al.'s patient-centred consultation skills programme to enhance communication, consultation, and health coaching skills [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough patients expressed satisfaction with the LMQ-3, the questionnaire lacks some essential information required to function as an outcome measure in a future clinical trial. Any PROM selected for future use should provide data on aspects including sensitivity to change, minimal clinically important differences, and baseline score estimates. There is a lack of relevant data in the literature for the LMQ-3.\u003c/p\u003e \u003cp\u003eThe eight-week follow-up period should be reconsidered, as some pharmacist recommendations were not yet implemented by general practitioners who reviewed patients on a three-monthly prescription cycle. A longer follow-up period would allow general practitioners more time to consider the pharmacist's recommendations and identify beneficial or hazardous effects that may only become evident long after the intervention [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe time allocated for each medication review should be extended to 60 minutes. However, it is important to consider the implications of this increased time allocation for healthcare stakeholders and funders, as it may require additional resources and impact capacity. Nevertheless, it is worth noting that the medication review in this intervention was comprehensive and involved patients with complex medication regimens. Therefore, each review required more time than a standard consultation addressing a medical concern. Research has also established that investing time in a comprehensive medication review can lead to savings elsewhere, including improvements in the quality of medication processes and time savings for other clinicians [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe strength of this study was the careful and deliberate approach used to evaluate the intervention. The study employed clear measures to assess intervention procedures and processes, including quantitative and qualitative assessment measures and progression criteria.\u003c/p\u003e \u003cp\u003eThe study had several constraints. Firstly, all participants received the intervention to test specific procedures and processes. As a result, aspects of the full-scale intervention, such as the recruitment of the control group, randomisation process, and allocation concealment, were beyond the scope of this study. Secondly, the study had a small sample size and a short follow-up period. However, the study was not designed to identify statistically significant long-term findings. Thirdly, the pharmacist and clinic were not blinded to the intervention, which could have influenced clinician behaviour and reported outcomes. Lastly, despite using established, careful methods to analyse qualitative data, the interviewer's involvement in the intervention's development could have biased feedback. Employing an independent interviewer might have reduced bias, but it was not feasible due to budget and logistic constraints.\u003c/p\u003e \u003cp\u003eThere is recognition that pharmacist-led interventions in primary care can reduce medication-related adverse effects, medication errors, and hospital admissions [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Therefore, this intervention is suitable for evaluation by general practice clinics interested in integrating pharmacists into their teams. Further research could investigate the effectiveness of incorporating the intervention as part of a Cornerstone Continuous Quality Improvement module for New Zealand general practice clinics to demonstrate their efforts in enhancing health outcomes [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor researchers, this study serves as an example of an intervention developed based on the Medical Research Council's best practice framework for developing and evaluating interventions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Despite the framework's availability since 2008, few interventions for older adults with polypharmacy have referenced it in their development [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Future research on similar interventions may benefit from adopting this framework to ensure that interventions are replicable, practical, and implementable across different settings.\u003c/p\u003e \u003cp\u003eLastly, this study underscores the importance of testing intervention procedures and processes for their feasibility. Despite the necessity of this stage, research suggests that feasibility evaluations are often overlooked [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Researchers may consider using the mixed-method approach employed in this study to design similar feasibility studies in future research.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe study's findings indicate that implementing the intervention into general practice is feasible; however, modifications are necessary before proceeding to a full-scale clinical trial.\u003c/p\u003e \u003cp\u003eThe next phase of this research programme will focus on developing a cluster-randomised controlled trial for the full-scale intervention. This trial will incorporate the changes identified in this study and provide details such as study duration, baseline data collection, definitive outcome measures, sample size, randomisation, blinding, and statistical methods. Additionally, it will include economic and process evaluations to investigate the cost-effectiveness of the intervention and identify barriers to implementing pharmacist recommendations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e The authors would like to thank Dr Bruce Stewart for his help in planning this study and feedback on the manuscript, Mr Adam Holloway for his help in producing the Figure 1 infographic, and the general practice clinic and patients who participated in this study for their time and contribution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors declare that no funds or grants were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e The authors declare no relevant financial or non-financial interests for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e The study adhered to the Declaration of Helsinki principles and received approval from the New Zealand Health and Disability Ethics Committees (reference number: 20/STH/238 date: 12/01/2021) and the New Zealand public health agency, Te Whatu Ora Te Pae Hauora o Ruahine o Tararua (reference \u0026nbsp;number: 2021.01.021 date: 20/04/2021).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate/publish:\u003c/strong\u003e All participants provided written informed consent to participate in the study. All participants provided informed consent to the publication of the study, with the understanding that it will not contain information that could identify them individually.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e The data generated during this study is available in Figshare, https://doi.org/10.17608/k6.auckland.24871563.v1\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e Conceptualisation: Lisheng Liu, Jeff Harrison, Bernadette Brokenshire, Deborah Davies; Methodology: Lisheng Liu, Jeff Harrison; Formal analysis and investigation: Lisheng Liu, Jeff Harrison; Writing \u0026ndash; original draft preparation: Lisheng Liu; Writing \u0026ndash; review and editing: Lisheng Liu, Jeff Harrison, Bernadette Brokenshire, Deborah Davies; Supervision: Jeff Harrison.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDurden M, Avery T, Payne R. Polypharmacy and medicines optimisation. United Kingdom: The King\u0026apos;s Fund; 2013. ISBN: 978 1 909029 18 7\u003c/li\u003e\n\u003cli\u003eScott I, Anderson K, Freeman C, et al. First do no harm: a real need to deprescribe in older patients. Med J Aust. 2014;201:390-392.\u003c/li\u003e\n\u003cli\u003eMinistry of Health. Pharmacy Action Plan. Wellington (NZ): Ministry of Health; 2016. ISBN 978-0-947515-13-3\u003c/li\u003e\n\u003cli\u003eRankin A, Cadogan C, Patterson S, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Syst Rev. 2018;9(9):CD008165.\u003c/li\u003e\n\u003cli\u003eLiu L, Harrison J. Development of explicit criteria identifying potentially inappropriate polypharmacy in older adults in New Zealand primary care: a mixed-methods study. J Prim Health Care. 2023; 15(1):38-47.\u003c/li\u003e\n\u003cli\u003eLiu L, Alate R, Harrison J. Development and validation of PolyScan, an information technology triage tool for older adults with polypharmacy: a healthcare informatics study. J Prim Health Care. 2023; 15(3):215-223.\u003c/li\u003e\n\u003cli\u003eMedical Research Council. Developing and evaluating complex interventions. In: Medical Research Council. The National Archives. 2019. https://webarchive.nationalarchives.gov.uk/ukgwa/20220207162925/http://mrc.ukri.org/documents/pdf/complex-interventions-guidance/. Accessed 05.04.2020. \u003c/li\u003e\n\u003cli\u003eMinistry of Health. Implementing medicines New Zealand 2015 to 2020. Wellington (NZ): Ministry of Health; 2015. ISBN: 978-0-478-44826-9.\u003c/li\u003e\n\u003cli\u003eThabane L, Ma J, Chu R, et al. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10:1.\u003c/li\u003e\n\u003cli\u003eKatusiime B, Corlett S, Krska J. Development and validation of a revised instrument to measure burden of long-term medicines use: the Living with Medicines Questionnaire version 3. Patient Relat Outcome Meas. 2018;9:155-168.\u003c/li\u003e\n\u003cli\u003eWuyts J, Maesschalck J, De Wulf I, et al. Studying the impact of a medication use evaluation for polymedicated older patients by the community pharmacist (SIMENON): study protocol. BMC Health Serv Res. 2018;18(1):623.\u003c/li\u003e\n\u003cli\u003eTordoff J, Brenkley C, Krska J, et al. Exploring medicines burden among adults in New Zealand: a cross-sectional survey. Patient Prefer Adherence. 2019;13:2171-2184.\u003c/li\u003e\n\u003cli\u003eBeyene K, Chan AHY, Bandreddi NST, et al. Patient satisfaction with community pharmacist-led anticoagulation management services and its relationship with patient characteristics in New Zealand. Int J Clin Pharm. 2021;43(1):154-164.\u003c/li\u003e\n\u003cli\u003eVan C, Costa D, Mitchell B, et al. Development and validation of a measure and a model of general practitioner attitudes towards collaboration with pharmacists. Res Social Adm Pharm. 2019;6(6):688-699.\u003c/li\u003e\n\u003cli\u003eRankin A, Cadogan C, Barry H, et al. An external pilot cluster randomised controlled trial of a theory-based intervention to improve appropriate polypharmacy in older people in primary care (PolyPrime): study protocol. Pilot Feasibility Stud. 2021;7:77.\u003c/li\u003e\n\u003cli\u003eAvery K, Williamson P, Gamble C, et al. Informing efficient randomised controlled trials: exploration of challenges in developing progression criteria for internal pilot studies. BMJ Open. 2017;7:e013537.\u003c/li\u003e\n\u003cli\u003eNowell L, Norris J, White D, et al. Thematic analysis: striving to meet the trustworthiness criteria. Int J Qual Methods. 2017;16.\u003c/li\u003e\n\u003cli\u003eMasnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17:230. \u003c/li\u003e\n\u003cli\u003eHikaka J, Jones R, Hughes C, et al. Clinical expertise, advocacy and enhanced autonomy \u0026ndash; acceptability of a pharmacist-facilitated medicines review intervention for community-dwelling Māori older adults. Explor Res Clin Soc Pharm. 2021;2:100010.\u003c/li\u003e\n\u003cli\u003eLacey C, Huria T, Beckert L, et al. The Hui Process: a framework to enhance the doctor-patient relationship with Māori. N Z Med J. 2011;124:72-78.\u003c/li\u003e\n\u003cli\u003eGrimes L, Barnett N. Consultation skills for pharmacy practice: taking a patient-centred approach. 2014. https://www.cppe.ac.uk/learningdocuments/pdfs/cppe_consultingskills.pdf. Accessed 10.05.2020.\u003c/li\u003e\n\u003cli\u003eBulbulia R, Bowman L, Wallendszus K, et al. Effects on 11-year mortality and morbidity of lowering LDL cholesterol with simvastatin for about 5 years in 20 536 high-risk individuals: a randomised controlled trial. Lancet. 2011;378:2013-2020.\u003c/li\u003e\n\u003cli\u003eFord I, Murray H, McCowan C, et al. Long-term safety and efficacy of lowering low-density lipoprotein cholesterol with statin therapy 20-year follow-up of west of Scotland coronary prevention study. Circulation. 2016;133:1073-1080.\u003c/li\u003e\n\u003cli\u003eEriksson T, Holdmdahl L, Midlov P, et al. The hospital LIMM-based clinical pharmacy service improves the quality of the patient medication process and saves time. Eur J Hosp Pharm. 2012;19:375-377.\u003c/li\u003e\n\u003cli\u003eLind K, Soeresen S, Salaman S, et al. Impact of clinical pharmacist intervention on length of stay in an acute admission unit: a cluster randomised study. Eur J Hosp Pharm. 2016;23:171-176.\u003c/li\u003e\n\u003cli\u003eAvery A, Rodgers S, Cantrill J, et al. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. Lancet. 2012;379:1310-1319.\u003c/li\u003e\n\u003cli\u003eRoyal S, Smeation L, Avery A, et al. Interventions in primary care to reduce medication related adverse events and hospital admissions: systematic review and meta-analysis. Qual Saf Health Care. 2006;15(1):23-31.\u003c/li\u003e\n\u003cli\u003eRomanelli R, Leahy A, Jukes T, et al. Pharmacist-led medication management program within a patient-centred medical home. Am J Health Syst Pharm. 2015;72(6):453-459.\u003c/li\u003e\n\u003cli\u003eThe Royal New Zealand College of General Practitioners. Continuous Quality Improvement module. In: Quality Programmes. The Royal New Zealand College of General Practitioners. 2020. https://www.rnzcgp.org.nz/Quality/Cornerstone/Continuous_Quality_Improvement_module/Quality/CQI_module/CQI_introduction.aspx. Accessed 05.12.2021.\u003c/li\u003e\n\u003cli\u003eEldridge S, Ashby D, Feder G, et al. Lessons for cluster randomised trials in the twenty-first century: a systematic review of trial in primary care. Clin Trials. 2004;1:80-90.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Aged, feasibility study, geriatrics, inappropriate prescribing, pharmacist, polypharmacy","lastPublishedDoi":"10.21203/rs.3.rs-3794044/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3794044/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePolypharmacy is associated with inappropriate prescribing and avoidable medicines-related harm. A novel pharmacist-led intervention has been developed to facilitate a targeted approach to identify and resolve inappropriate prescribing in older adults with polypharmacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/em\u003eTo conduct a preliminary feasibility assessment of the intervention in primary care, testing whether specific components of the intervention procedures and processes can be executed as intended.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eIn this mixed-methods study, patients were recruited from a New Zealand general practice clinic over a four-week recruitment period to receive the intervention. Process fidelity, patient, and clinician perspectives were collected. Quantitative data were analysed based on the study's progression criteria to determine whether a clinical trial of the full-scale intervention is warranted. Qualitative data were subjected to thematic analysis to identify facilitators and barriers to implementation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe intervention met the study's progression criteria, including patient recruitment, retention, and adherence to the intervention procedures. However, several modifications were identified, including: 1) enhancing patient recruitment, 2) conducting a preliminary meeting between the patient and pharmacist, 3) supporting pharmacists in maintaining a patient-centred approach, 4) reviewing the choice of patient-reported outcome measure, 5) extending the eight-week follow-up period, \u0026nbsp;6) allocating more time for pharmacists to conduct the intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe study concluded that the intervention is feasible; however, additional development is required before progressing to a full-scale trial. This intervention holds the potential to provide an efficient approach to reducing medication-related harm and improving outcomes for older adults with polypharmacy.\u003c/p\u003e\n\u003ch3\u003eTrial registration number: ACTRN12621000268842 Date registered: 11/03/2021\u003c/h3\u003e","manuscriptTitle":"Preliminary feasibility assessment of a targeted, pharmacist-led intervention for older adults with polypharmacy: a mixed-methods study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-03 20:22:07","doi":"10.21203/rs.3.rs-3794044/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revisions","date":"2024-02-15T01:04:31+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2023-12-27T21:51:50+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-12-22T07:33:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-12-22T01:37:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Clinical Pharmacy","date":"2023-12-21T15:40:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"4711372f-b64b-430d-a55c-15fb9eec8457","owner":[],"postedDate":"January 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-04-05T16:41:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-03 20:22:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3794044","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3794044","identity":"rs-3794044","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}