The Care Home Independent Pharmacist Prescriber Study (CHIPPS): development and implementation of an RCT to estimate safety, effectiveness and cost-effectiveness

Wright, David, Holland, Richard, Alldred, David Phillip, Bond, Christine, Hughes, Carmel, Barton, Garry, Poland, Fiona ORCID: https://orcid.org/0000-0003-0003-6911, Shepstone, Lee, Arthur, Antony, Birt, Linda, Blacklock, Jeanette, Blyth, Annie, Cheilari, Stamatina, Daffu-O’Reilly, Amrit, Dalgarno, Lindsay, Desborough, James ORCID: https://orcid.org/0000-0001-5807-1731, Ford, Joanna, Grant, Kelly, Gray, Janet, Handford, Christine, Harry, Bronwen, Hill, Helen, Inch, Jacqueline, Myint, Phyo Kyaw, Norris, Nigel, Spargo, Maureen, Maskrey, Vivienne, Turner, David ORCID: https://orcid.org/0000-0002-1689-4147, Watts, Laura and Zermansky, Arnold (2023) The Care Home Independent Pharmacist Prescriber Study (CHIPPS): development and implementation of an RCT to estimate safety, effectiveness and cost-effectiveness. Programme Grants for Applied Research, 11 (10). ISSN 2050-4322

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Abstract

Background: Medicine prescribing, monitoring and administration in care homes can be significantly enhanced. Effective interventions to improve pharmaceutical care and resident outcomes are required. The enablement of pharmacists to prescribe provides an opportunity for pharmacist independent prescribers to assume responsibility for improving pharmaceutical care, medication-related outcomes and resident safety whilst reducing general practitioner workload. Objective(s): To determine the effectiveness and cost-effectiveness of pharmacist independent prescribing in care homes. Design: Development work was undertaken through five work packages before the delivery of the definitive trial. Triads of pharmacist independent prescribers, care home and general practice with responsibility over 20 care home residents were recruited and cluster randomised to intervention or usual care for 6 months. Researchers were blinded at recruitment stage only. Recruitment of 880 residents was required to provide 80% statistical power, to show a 21% reduction in falls over 6 months, assuming 20% attrition. Randomisation was undertaken electronically at triad level, stratified by geographical area. Intention-to-treat analysis undertaken using a negative binomial model. Parameters were estimated using a generalised estimating equation approach. Costs were captured from an NHS perspective. Quality of life (EuroQol; five domain; five level) was collected by proxy to enable cost/ quality-adjusted life-year estimation. A concurrent process evaluation was performed. Safety was monitored through a review of pharmacist independent prescriber activities, independent concerns reporting and review of adverse events. Participants: Forty-nine triads of general practitioners, pharmacist independent prescribers and care homes were recruited with 454 residents allocated to the intervention arm and 428 to the control arm. Intervention: Medication review and care planning, medication reconciliation, staff training, support with care home medication-related procedures, deprescribing and authorisation of monthly prescriptions. Main outcome measure: Fall rate per person over ó months. Results: Data for 449 intervention and 427 control residents available for final analysis.

Item Type: Article
Additional Information: Funding Information: The research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0613-20007. Other information: The contractual start date was in May 2015. The final report began editorial review in July 2021 and was accepted for publication in October 2022. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.
Faculty \ School: Faculty of Science > School of Pharmacy
Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Medicine and Health Sciences > School of Health Sciences
Faculty of Social Sciences > School of Economics
Faculty of Social Sciences > School of Education and Lifelong Learning
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging
Faculty of Medicine and Health Sciences > Research Centres > Population Health
Faculty of Medicine and Health Sciences > Research Groups > Health Economics
Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care
Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit
Faculty of Medicine and Health Sciences > Research Centres > Institute for Volunteering Research
Faculty of Medicine and Health Sciences > Research Groups > Dementia & Complexity in Later Life
Faculty of Science > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health
Faculty of Science > Research Groups > Innovations in Pharmacy Education
Faculty of Science > Research Groups > Patient Care
Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health
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Depositing User: LivePure Connector
Date Deposited: 12 Jan 2024 01:40
Last Modified: 13 Jul 2024 01:49
URI: https://ueaeprints.uea.ac.uk/id/eprint/94151
DOI: 10.3310/JBPT2117

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