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Table 1 Description of draft interventions

From: Development of an intervention to improve appropriate polypharmacy in older people in primary care using a theory-based method

Intervention 1: Patient-targeted intervention
 Target group: older patients (≥65 years) receiving polypharmacy
 Target behaviour: not applicablea
 Intervention description: The intervention would be delivered to target patients either through the form of a letter from the GP inviting patients to attend a review consultation (‘Prompts/cues’) or as a coloured label that community pharmacists would attach to patients’ dispensed medication prompting patients to visit their GP for a review consultation (‘Prompts/cues’). GPs would then plan to ensure that patients are prescribed appropriate polypharmacy when they present at the practice (‘Action planning’).
Intervention 2: General practice-based intervention
 Target group: GPs
 Target behaviour: prescribing of appropriate polypharmacy
 Intervention description: The intervention would be delivered through a short online video (or series of videos) demonstrating how GPs can prescribe appropriate polypharmacy during a typical consultation with an older patient (‘Modelling or demonstrating of behaviour’). Each video would last the duration of an average GP consultation (approximately 10 min) and also include feedback from both the GP and patient emphasising the positive outcomes of the consultation (‘Salience of consequences’). As complementary intervention components, GPs would make an explicit plan at practice meetings of when and how they would ensure that target patients are prescribed appropriate polypharmacy (‘Action planning’) and they would be prompted to carry out this plan by the receptionist when target patients present at the practice (‘Prompts/cues’).
Intervention 3: Community pharmacy-based intervention
 Target group: community pharmacists
 Target behaviour: dispensing of appropriate polypharmacy
 Intervention description: The intervention would be delivered through a short online video (or series of videos), similar to that outlined in the GP-based intervention. The video would operationalise two BCTs (‘Modelling or demonstrating of behaviour’, ‘Salience of consequences’) by demonstrating how pharmacists can dispense appropriate polypharmacy during a typical encounter with an older patient and including feedback from both the pharmacist and patient emphasising the positive outcomes of this process.
 Patients would be targeted using a collaborative approach between the GP practice and pharmacy. Patients would be identified initially by the GP practice. A list of GP-approved patients would be provided to the pharmacy which would authorise pharmacists to engage with target patients when they present at the pharmacy (‘Social support or encouragement’).
 Having been provided with access to the online video(s) together with the list of target patients, pharmacists would make an explicit plan of when and how they would ensure that patients meeting inclusion criteria are dispensed appropriate polypharmacy (‘Action planning’). Pharmacists would be prompted to enact this plan when patients present at the pharmacy either by support staff or a note on the individual patient’s dispensing record (‘Prompts/cues’). Any recommended changes to patients’ current medications would be communicated to the GPs by the pharmacists.
  1. aNot applicable: the target behaviour of this draft intervention was not one of the two pre-specified target behaviours (i.e. prescribing and dispensing of appropriate polypharmacy)