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

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Key Summary points

AbstractSection 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.

AbstractSection 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.

AbstractSection Message

We identified relevant intervention elements and their accompanying behavior change techniques to aid in the development of a context-specific intervention.

Abstract

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.

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Data availability

All data generated and analyzed for this study are available within the article and its supplementary information.

Code availability

Not applicable.

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Acknowledgements

We would like to thank our Delphi panel experts for their time and dedication in this study and Ms Kate Ying for planning, formulating, and reviewing the Delphi statements for the first round of the survey. None received compensation for their contributions. This study is funded by the Geriatric Education and Research Institute, Singapore.

Funding

This study is funded by the Geriatric Education and Research Institute, Singapore through the Intramural Grant Award (GERI1622) for the project “Appropriate prescribing for older adults with multimorbidity: from barriers to solutions”.

Author information

Authors and Affiliations

  1. Geriatric Education and Research Institute Limited, 2 Yishun Central 2, Singapore, 768024, Singapore

    Jia Ying Tang, Penny Lun, Poh Hoon June Teng & Yew Yoong Ding

  2. Department of Pharmacy, Changi General Hospital, Singapore, Singapore

    Wendy Ang

  3. Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore

    Keng Teng Tan

  4. Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore

    Yew Yoong Ding

Authors
  1. Jia Ying Tang
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  2. Penny Lun
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  3. Poh Hoon June Teng
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  4. Wendy Ang
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  5. Keng Teng Tan
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  6. Yew Yoong Ding
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Contributions

Study design PL, WA, KTT and YYD. Data collection and analysis JYT, PL, PHJT and YYD. Manuscript preparation JYT, PL, PHJT, WA, KTT and YYD. All authors listed provided feedback on draft versions of the paper and approved the final manuscript in its current version.

Corresponding author

Correspondence to Jia Ying Tang.

Ethics declarations

Conflict of interest

The authors declare no relevant conflict of interest.

Ethical approval

The study was granted ethical approval by the National Health Group Domain Specific Review Board, Singapore (NHG DSRB Ref: 2019/00521).

Consent to participate and for publication

Informed consent was obtained from all individual participants included in the study.

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Supplementary Information

Below is the link to the electronic supplementary material.

41999_2021_566_MOESM1_ESM.pdf

Supplementary file1 Supplementary material 1: Round one survey questions for Delphi study: Intervention Elements to Reduce Inappropriate Prescribing for Older Adults (PDF 203 KB)

41999_2021_566_MOESM2_ESM.pdf

Supplementary file2 Supplementary material 2: Round two survey questions for Delphi study: Intervention Elements to Reduce Inappropriate Prescribing for Older Adults (PDF 147 KB)

41999_2021_566_MOESM3_ESM.pdf

Supplementary file3 Supplementary table 1: BCTs statements with high group agreement for low importance. The mapped intervention functions and their associated BCTs with the statements adapted for the survey are shown (PDF 80 KB)

41999_2021_566_MOESM4_ESM.pdf

Supplementary file4 Supplementary table 2: BCTs statements with low group agreement. The mapped intervention functions and their associated BCTs with the statements adapted for the survey are shown (PDF 16 KB)

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Tang, J.Y., Lun, P., Teng, P.H.J. et al. Intervention elements and behavior change techniques to improve prescribing for older adults with multimorbidity in Singapore: a modified Delphi study. Eur Geriatr Med 13, 531–539 (2022). https://doi.org/10.1007/s41999-021-00566-5

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  • DOI: https://doi.org/10.1007/s41999-021-00566-5

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