By Carina Lundby, Wade Thompson and Anton Pottegård
In the Research Unit at Hospital Pharmacy Funen, Odense University Hospital, Denmark, deprescribing constitutes our main research area. Although we are a small group of researchers, we have worked with deprescribing in many different ways over the last years. We will get back to that. First, let’s go back to where it all started.
Our research unit was founded in the fall of 2016. At this point, Anton @Pottegard was appointed as Head of Research. However, he also constituted the entire research group – and was only employed part-time. Unsurprisingly, not a lot gets done when your research unit consists of no one but yourself. Therefore, after a few months, @CarinaLundby and Lene (clinical pharmacist) were brought in. And with resources, we suddenly had to come up with a game plan for the research unit.
The first focus area was a given. Lene and Anton had both been part of a large randomized controlled trial focusing on improving patients’ transition from hospital to primary care. This study, published in JAMA Internal Medicine, found some really convincing results, documenting that a multifaceted clinical pharmacist intervention can reduce the number of hospital readmissions and emergency department visits. Eager to explore how to further improve patients’ transitions of care, it was quickly decided that sector transitions should constitute one of our research focuses.
However, another important theme was quickly identified. Almost a decade ago, Anton had worked with optimizing medical treatment in nursing homes. Ever since then, he had been contemplating revisiting this setting, but with a new focus: Reduction of unnecessary therapy. More specifically to shift focus to what matters to the individual patient rather than what all the clinical treatment guidelines dictate. And in 2017, followed by a larger grant from the Velux Foundations, our deprescribing adventure suddenly started, with our primary focus being on older patients with limited life expectancy.
Odense Deprescribing INitiative (ODIN)
Following the initial grant in 2017 and two more in 2018 and 2019, our deprescribing portfolio and group of deprescribing collaborators grew from being relatively small and national-based to suddenly include a number of different research activities and a wide range of national and international collaborators. We are engaged in a wide range of research methodologies, including qualitative research and survey development, observational studies, clinical research, and implementation activities. To formalize our deprescribing research, we recently launched the Odense Deprescribing INitiative (ODIN), a collaboration between four research units located in Odense, Denmark: the Hospital Pharmacy and Geriatric Department Research Units at Odense University Hospital as well as the General Practice and Clinical Pharmacology and Pharmacy Research Units at University of Southern Denmark. With ODIN, we aim to facilitate more rational use of medication through deprescribing research and implementation activities. Within ODIN, we currently have three main portfolios:
Attitudes towards deprescribing
We explore attitudes towards deprescribing from the perspective of patients, relatives, and health care professionals. We do this to get a better understanding of what may hinder as well as facilitate deprescribing, as this will help us to develop interventions, tools, and strategies that may improve the uptake of deprescribing in clinical practice. We explore patient/relative and prescriber perspectives through systematic reviews, qualitative studies, and surveys.
We will conduct a randomized controlled trial to test whether a comprehensive and patient-centered deprescribing intervention, focused on aligning medical treatment with the patient’s preferences, can improve quality of life among older patients with limited life expectancy. The intervention will be carried out in collaboration between the patient and general practitioner. A pilot is currently underway. The trial will be started during the summer of 2020.
Deprescribing.org have developed tools to deprescribe PPIs. In this project, we will test two such tools. Eligible patients, that is, those with no ongoing indication for treatment, will be recruited at community pharmacies and randomized 1:1 to a simple intervention or an extended intervention. The simple intervention will provide patients with a pamphlet on PPI deprescribing. The extended intervention is the patient pamphlet and an individual telephone consultation with a pharmacist where a collaborative plan for PPI deprescribing is developed. A pilot study will be initiated during the summer of 2020.
Through extensive use of Twitter, we came to realize that deprescribing research in Europe is much more fragmented compared to strong deprescribing communities in e.g. Canada and Australia. So in 2019, we decided to establish the Northern European Researchers in Deprescribing (NERD) Network. With NERD, we aim to support collaboration between deprescribing researchers and increase the visibility of deprescribing in Northern Europe. Ultimately, we aim to strengthen collaborations and partnerships in deprescribing across countries and networks, with the hope of moving the field forward, addressing research gaps, and spreading knowledge and implementation of deprescribing.
Where are we now?
We have now grown to a group of 10 researchers, including postdocs, PhD students, and halftime researchers/halftime clinicians, and we are now one of the leading research units in Denmark in terms of both deprescribing research and output related to this field. Our full list of publications can be found here.
We want to collaborate with you!
Despite being busy, collaboration is central to us – and we are thus always looking for new people to discuss and exchange research ideas as well as people to engage in more formal collaborations with. If you have any ideas that you would like to discuss or simply would like to hear more about our projects, please don’t hesitate to contact us.
The deprescribing blog is hosted by pharmacists and PhD students, Carina Lundby and Wade Thompson. We hope to be your new best deprescribing friends and supply you with deprescribing content and analysis on a biweekly basis. Please reach out to us if you have any questions or comments, or would like to contribute.