Cargando…

Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)––a realist synthesis

BACKGROUND: Medication-related adverse events have been estimated to be responsible for 5700 deaths and cost the UK £750 million annually. This burden falls disproportionately on older people. Outcomes from interventions to optimise medication management are caused by multiple context-sensitive mech...

Descripción completa

Detalles Bibliográficos
Autores principales: Maidment, Ian, Booth, Andrew, Mullan, Judy, McKeown, Jane, Bailey, Sylvia, Wong, Geoffrey
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496371/
https://www.ncbi.nlm.nih.gov/pubmed/28673335
http://dx.doi.org/10.1186/s13643-017-0528-1
_version_ 1783247965429694464
author Maidment, Ian
Booth, Andrew
Mullan, Judy
McKeown, Jane
Bailey, Sylvia
Wong, Geoffrey
author_facet Maidment, Ian
Booth, Andrew
Mullan, Judy
McKeown, Jane
Bailey, Sylvia
Wong, Geoffrey
author_sort Maidment, Ian
collection PubMed
description BACKGROUND: Medication-related adverse events have been estimated to be responsible for 5700 deaths and cost the UK £750 million annually. This burden falls disproportionately on older people. Outcomes from interventions to optimise medication management are caused by multiple context-sensitive mechanisms. The MEdication Management in Older people: REalist Approaches BAsed on Literature and Evaluation (MEMORABLE) project uses realist synthesis to understand how, why, for whom and in what context interventions, to improve medication management in older people on complex medication regimes residing in the community, work. METHOD: This realist synthesis uses secondary data and primary data from interviews to develop the programme theory. A realist logic of analysis will synthesise data both within and across the two data sources to inform the design of a complex intervention(s) to help improve medication management in older people. 1. Literature review. The review (using realist synthesis) contains five stages to develop an initial programme theory to understand why processes are more or less successful and under which situations: focussing of the research question; developing the initial programme theory; developing the search strategy; selection and appraisal based on relevance and rigour; and data analysis/synthesis to develop and refine the programme theory and context, intervention and mechanism configurations. 2. Realist interviews. Realist interviews will explore and refine our understanding of the programme theory developed from the realist synthesis. Up to 30 older people and their informal carers (15 older people with multi-morbidity, 10 informal carers and 5 older people with dementia), and 20 care staff will be interviewed. 3. Developing framework for the intervention(s). Data from the realist synthesis and interviews will be used to refine the programme theory for the intervention(s) to identify: the mechanisms that need to be ‘triggered’, and the contexts related to these mechanisms. Intervention strategies that change the contexts so the mechanisms are triggered to produce desired outcomes will be developed. Feedback on these strategies will be obtained. DISCUSSION: This realist synthesis aims to develop a framework (underpinned by our programme theory) for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016043506 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13643-017-0528-1) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-5496371
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-54963712017-07-05 Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)––a realist synthesis Maidment, Ian Booth, Andrew Mullan, Judy McKeown, Jane Bailey, Sylvia Wong, Geoffrey Syst Rev Protocol BACKGROUND: Medication-related adverse events have been estimated to be responsible for 5700 deaths and cost the UK £750 million annually. This burden falls disproportionately on older people. Outcomes from interventions to optimise medication management are caused by multiple context-sensitive mechanisms. The MEdication Management in Older people: REalist Approaches BAsed on Literature and Evaluation (MEMORABLE) project uses realist synthesis to understand how, why, for whom and in what context interventions, to improve medication management in older people on complex medication regimes residing in the community, work. METHOD: This realist synthesis uses secondary data and primary data from interviews to develop the programme theory. A realist logic of analysis will synthesise data both within and across the two data sources to inform the design of a complex intervention(s) to help improve medication management in older people. 1. Literature review. The review (using realist synthesis) contains five stages to develop an initial programme theory to understand why processes are more or less successful and under which situations: focussing of the research question; developing the initial programme theory; developing the search strategy; selection and appraisal based on relevance and rigour; and data analysis/synthesis to develop and refine the programme theory and context, intervention and mechanism configurations. 2. Realist interviews. Realist interviews will explore and refine our understanding of the programme theory developed from the realist synthesis. Up to 30 older people and their informal carers (15 older people with multi-morbidity, 10 informal carers and 5 older people with dementia), and 20 care staff will be interviewed. 3. Developing framework for the intervention(s). Data from the realist synthesis and interviews will be used to refine the programme theory for the intervention(s) to identify: the mechanisms that need to be ‘triggered’, and the contexts related to these mechanisms. Intervention strategies that change the contexts so the mechanisms are triggered to produce desired outcomes will be developed. Feedback on these strategies will be obtained. DISCUSSION: This realist synthesis aims to develop a framework (underpinned by our programme theory) for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016043506 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13643-017-0528-1) contains supplementary material, which is available to authorized users. BioMed Central 2017-07-03 /pmc/articles/PMC5496371/ /pubmed/28673335 http://dx.doi.org/10.1186/s13643-017-0528-1 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Protocol
Maidment, Ian
Booth, Andrew
Mullan, Judy
McKeown, Jane
Bailey, Sylvia
Wong, Geoffrey
Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)––a realist synthesis
title Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)––a realist synthesis
title_full Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)––a realist synthesis
title_fullStr Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)––a realist synthesis
title_full_unstemmed Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)––a realist synthesis
title_short Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)––a realist synthesis
title_sort developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (memorable)––a realist synthesis
topic Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496371/
https://www.ncbi.nlm.nih.gov/pubmed/28673335
http://dx.doi.org/10.1186/s13643-017-0528-1
work_keys_str_mv AT maidmentian developingaframeworkforanovelmultidisciplinarymultiagencyinterventionstoimprovemedicationmanagementincommunitydwellingolderpeopleoncomplexmedicationregimensmemorablearealistsynthesis
AT boothandrew developingaframeworkforanovelmultidisciplinarymultiagencyinterventionstoimprovemedicationmanagementincommunitydwellingolderpeopleoncomplexmedicationregimensmemorablearealistsynthesis
AT mullanjudy developingaframeworkforanovelmultidisciplinarymultiagencyinterventionstoimprovemedicationmanagementincommunitydwellingolderpeopleoncomplexmedicationregimensmemorablearealistsynthesis
AT mckeownjane developingaframeworkforanovelmultidisciplinarymultiagencyinterventionstoimprovemedicationmanagementincommunitydwellingolderpeopleoncomplexmedicationregimensmemorablearealistsynthesis
AT baileysylvia developingaframeworkforanovelmultidisciplinarymultiagencyinterventionstoimprovemedicationmanagementincommunitydwellingolderpeopleoncomplexmedicationregimensmemorablearealistsynthesis
AT wonggeoffrey developingaframeworkforanovelmultidisciplinarymultiagencyinterventionstoimprovemedicationmanagementincommunitydwellingolderpeopleoncomplexmedicationregimensmemorablearealistsynthesis