Intervention elements and behavior change techniques to improve prescribing for older adults with multimorbidity in Singapore: a modified Delphi study

• Published in: European geriatric medicine Vol. 13; no. 3; pp. 531 - 539
• Main Authors: Tang, Jia Ying, Lun, Penny, Teng, Poh Hoon June, Ang, Wendy, Tan, Keng Teng, Ding, Yew Yoong
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2022
• Subjects: Geriatrics/Gerontology; Internal Medicine; Medicine; Medicine & Public Health; Research Paper; Outpatients; System analysis; Inappropriate prescribing; Implementation science; Geriatrics
• ISSN: 1878-7649; 1878-7657; 1878-7657
• DOI: 10.1007/s41999-021-00566-5

Key Summary points Aims A modified Delphi study was conducted to (1) identify intervention elements that are considered by geriatricians to be important in optimizing prescribing for older adults with multimorbidity, and (2) to select the accompanying behavior change techniques to be incorporated into a context-relevant intervention to support prescribing. Findings Intervention elements such as medication review identified by the Delphi panel mirrored results from a previous scoping review. Statements involving roles of pharmacists selected by the panel validated findings in the literature that pharmacists play important collaborative roles to help reduce potentially inappropriate prescribing among older adults with multimorbidity. Message We identified relevant intervention elements and their accompanying behavior change techniques to aid in the development of a context-specific intervention. Purpose Potentially inappropriate prescribing among older adults is a rising concern, attributed mainly by polypharmacy and multimorbidity. We aimed to identify key components and strategies for construction of a context-relevant intervention to facilitate appropriate prescribing in outpatient clinics in Singapore. Methods The modified Delphi study was conducted in two rounds with 20 geriatricians from seven public hospitals in Singapore. Round one survey presented 69 statements formulated from a scoping review, while round two presented 23 statements with some modifications based on round one comments. The statements were rated against a 7-point Likert scale on their importance and impact on prescribing for older adults with multimorbidty. Results Consensus were achieved for 90% of the statements. Seven intervention elements were identified as being important: medication review, training, medication therapy management, shared decision making, patient interview, medication reconciliation, comprehensive geriatric assessment. In addition, some commonly identified behavior change techniques included goal setting (behavior), goal setting (outcome) and problem solving. Conclusions This study identified important intervention elements and their potential strategies that could be adopted in an intervention to optimize appropriate prescribing for older adults with multimorbidity.