Evaluation of the CompreHensive geriAtRician-led MEdication Review (CHARMER) deprescribing intervention in hospital: protocol for a cluster randomised stepped-wedge trial

Wright, David john, Alldred, David Phillip, Scott, Sion, Atkins, Bethany, Clark, Allan B., Colles, Antony, Hammond, Amber, Jones, Charlotte E. L., Martin-Kerry, Jacqueline M., Patel, Martyn, Sims, Erika, Turner, David, Witham, Miles and Bhattacharya, Debi (2026) Evaluation of the CompreHensive geriAtRician-led MEdication Review (CHARMER) deprescribing intervention in hospital: protocol for a cluster randomised stepped-wedge trial. BMJ Open, 16 (3). ISSN 2044-6055

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Abstract

Background: While almost half of older adults admitted to hospital are prescribed potentially inappropriate medicines, less than 1% have a medicine proactively deprescribed during admission in the UK. The CompreHensive geriAtRician-led MEdication Review (CHARMER) intervention is designed to address geriatricians’ and pharmacists’ barriers and enablers to deprescribing. The CHARMER definitive trial will evaluate effectiveness, cost-effectiveness and safety. Methods: A stepped-wedge cluster randomised controlled trial will be conducted in 20 hospitals in England, with four hospitals in reserve. All hospitals will collect baseline data. Every 3 months, five hospitals will be randomised to receive the intervention. The intervention, implemented by a local project manager, comprises a hospital action plan to set deprescribing as an organisational goal; workshops for pharmacists and geriatricians to change beliefs about deprescribing; weekly briefings between geriatricians and pharmacists to discuss opportunities for deprescribing; benchmarking reports to compare deprescribing performance across participating hospitals. With an average of 200 patients admitted and discharged during each step, the study will have 89.5% power at 5% significance level and intra-class correlation coefficient of 0.05 to detect a 3% difference in 90-day re-admission rate from 16.7% versus 13.7%. Anonymised routinely collected data, including readmissions, will be obtained for all patients admitted during the study period. Enhanced data collection periods of 1 month during control and intervention periods will be used to recruit patients and data for secondary outcomes and process evaluation. Discussion: A stepped-wedge design enabled a smaller number of hospitals and patients to be included than a traditional cluster-randomised design. The complexity of intervention implementation necessitated a project manager in addition to the principal investigator responsible for trial conduct. Using routinely collected data for the primary outcome measure should ensure that the trial has sufficient power on completion. Planned enhanced data collection for short periods of time improves trial efficiency.

Item Type:	Article
Additional Information:	Data sharing: The protocol will be available on the NIHR website and within the ISRCTN register. The datasets generated during and/or analysed during the current study are not expected to be made available due to data sharing restrictions as part of section 251 approval and NHS England governance requirements. Statistical code will be available on request from allan.clark@uea.ac.uk.
Uncontrolled Keywords:	hospital,proactive deprescribing,pharmacist,consultant geriatrician,medication review,behaviour change,older adult
Faculty \ School:	Faculty of Science > School of Chemistry, Pharmacy and Pharmacology Faculty of Medicine and Health Sciences > School of Health Sciences Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Behavioural and Implementation Science for Health and Care Faculty of Science > Research Groups > Statistics Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Centres > Public Health Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Medicine and Health Sciences > Research Centres > Mental Health and Social Care (fka Lifespan Health) Faculty of Medicine and Health Sciences > Research Groups > Health Economics
Related URLs:	https://bmjopen.bmj.com/lookup/doi/10.11...
Depositing User:	LivePure Connector
Date Deposited:	04 Feb 2026 23:10
Last Modified:	09 Apr 2026 12:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/101834
DOI:	10.1136/bmjopen-2025-107396

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