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Table 1 Top-five ranked questions by topic area

From: A multi-stakeholder approach to the co-production of the research agenda for medicines optimisation

Topic area Overall rank Question PPI rank (n = 7) Non-PPI rank (n = 25)
Patient Concerns (PC) 1 To what extent are patients’ views and experiences considered during medication reviews? 3 1
2 *Is there a shared decision (with patients) about using each medicine? 1 2
3 How are medication reviews by different healthcare professionals integrated? 2 5
4 How can communication relevant to medication reviews be enhanced across and within sectors? 5 3
5 What information/education would patients require regarding polypharmacy to engage and take some ownership? 7 6
Polypharmacy (P) 1 *To what extent should polypharmacy involve patients’ views and preferences in shared decision making? 1 5
2 *If we undertake a polypharmacy medication review well with the right person at the right time, what happens to the patient (i.e. are their outcomes better, does their quality of life (QoL) improve etc.)? 5 2
3 *How can we reengineer primary care to make time for medication review to be done well by the right people (since this is only going to get bigger i.e. more older people on more drugs)? 8 2
4 How do we achieve a “culture shift” to prevent polypharmacy (including engagement with public, addressing socioeconomic disparities)? 13 1
5 How should health services be redesigned to cope with polypharmacy/multimorbidity? 11 2
Non-medical Prescribing (NMP) 1 How can we optimise the contribution of non-medical prescribers to primary care? 1 1
2 How is deprescribing, polypharmacy, etc. undertaken by non-medical prescribers? 5 2
3 What are the influences on deprescribing behaviour of non-medical prescribers? 7 3
4a To what extent does NMP training provide HCPs with the confidence to address complex polypharmacy and deprescribing issues with patients; address inappropriate polypharmacy? 9 4
4b What is the role of the NMP in medicines reviews (e.g. in specialist areas such as rheumatology and type of NMP e.g. pharmacist, nurse)? 3 6
Deprescribing (D) 1 *How can we empower patients to take a more active role in self-management and self-monitoring of multiple long-term conditions, including deprescribing? 1 1
2 To what extent is shared decision-making incorporated into deprescribing consultations? 19 1
3 Where are the gaps in education and training (about deprescribing) and how these can be addressed is key to ensuring deprescribing is safe and effective? 7 3
4 Should all ‘prescribing’ guidelines include recommendations to deprescribe, and if so how? 2 9
5 What should the core outcome set be for deprescribing interventions? 9 4
  1. Italicised items represent additional questions suggested by stakeholders during Stage 2; ranks with suffix ‘a’, ‘b’ represent equivalent median scores. Questions receiving an ‘extremely important’ or ‘important’ rating from at least three-quarters of participants are indicated with *