Background Deprescribing is a positive, patient-centred, safe, effective, and cost-efficient process. It takes time, skill, confidence, and teamwork. It is an established part of good holistic care therefore suitable for quality improvement.
Study Aim and Methods This Quality Improvement Project was conducted at the interface of community palliative care and General practice in Southwest England. The aim was ‘For 100% of patients on the palliative care registers in South Somerset West Primary Care Network to have the opportunity of a deprescribing conversation with a skilled healthcare professional between diagnosis and death’. Four GP surgeries under one management participated (patient population 37,107). Background data collection evidenced the problem and highlighted that the register numbers did not reflect the national expected prevalence (Gold Standard Framework estimate prevalence at 1%). This had to be addressed to make the project equitable. Process mapping and discussion of primary and secondary drivers informed initial interventions including re-establishing regular multidisciplinary team meetings, creating a coded template to improve their structure and aid documentation and data collection and education. Eleven Plan Do Study Act cycles ensued over eight months.
Results The percentage of patients on the palliative care registers having the opportunity of a deprescribing conversation increased from 0% to 33%. This process measure proved more responsive to change than the outcome measure. The register size increased from 0.2% to 0.39% of the practice population. The most successful interventions were education (p>95% causative) and ensuring key professionals were available, highlighting the need for cultural change and the impact of human factors. Simple IT interventions were also effective.
Conclusion The aim was unrealistic in the timeframe because deprescribing could not be isolated from improvement in holistic care (benefit acknowledged, future research needed). Limitations included lack of staff cover. Continued work at these sites plus local expansion is planned.
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