Process evaluation for the Care Homes Independent Pharmacist Prescriber Study (CHIPPS)

Linda Birt* (Corresponding Author), Lindsay Dalgarno, David John Wright, Mohammed Alharthi, Jacqueline Inch, Maureen Spargo, Jeanette Blacklock, Fiona Poland, Richard Charles Holland, David P Alldred, Carmel M Hughes, Christine Bond, CHIPPS Team

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)
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BackgroundMedicines management in care homes requires significant improvement. CHIPPS was a cluster randomised controlled trial to determine the effectiveness of integrating pharmacist independent prescribers into care homes to assume central responsibility for medicines management. This paper reports the parallel mixed-methods process evaluation.MethodIntervention arm consisted of 25 triads: Care homes (staff and up to 24 residents), General Practitioner (GP) and Pharmacist Independent Prescriber (PIP). Data sources were pharmaceutical care plans (PCPs), pharmacist activity logs, online questionnaires and semi-structured interviews. Quantitative data were analysed descriptively. Qualitative data were analysed thematically. Results were mapped to the process evaluation objectives following the Medical Research Council framework.ResultsPCPs and activity logs were available from 22 PIPs. Questionnaires were returned by 16 PIPs, eight GPs, and two care home managers. Interviews were completed with 14 PIPs, eight GPs, nine care home managers, six care home staff, and one resident. All stakeholders reported some benefits from PIPs having responsibility for medicine management and identified no safety concerns. PIPs reported an increase in their knowledge and identified the value of having time to engage with care home staff and residents during reviews. The research paperwork was identified as least useful by many PIPs. PIPs conducted medication reviews on residents, recording 566 clinical interventions, many involving deprescribing; 93.8% of changes were sustained at 6 months. For 284 (50.2%) residents a medicine was stopped, and for a quarter of residents, changes involved a medicine linked to increased falls risk. Qualitative data indicated participants noted increased medication safety and improved resident quality of life. Contextual barriers to implementation were apparent in the few triads where PIP was not known previously to the GP and care home before the trial. In three triads, PIPs did not deliver the intervention.ConclusionsThe intervention was generally implemented as intended, and well-received by most stakeholders. Whilst there was widespread deprescribing, contextual factors effected opportunity for PIP engagement in care homes. Implementation was most effective when communication pathways between PIP and GP had been previously well-established.
Original languageEnglish
Article number1041
Number of pages15
JournalBMC Health Services Research
Issue number1
Early online date2 Oct 2021
Publication statusPublished - 2 Oct 2021

Bibliographical note

This is a summary of independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0613-20007). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.

Thank you to residents and their families who agreed to receive the intervention, the pharmacists, GP practices and care homes who delivered the intervention and took part in the process evaluation. We would also like to acknowledge the South Norfolk Clinical Commissioning Group as the study sponsor and the CHIPPS Study team including members who supported production of this manuscript through analyses of study records: Annie Blyth, Laura Watts, Amrit Daffu-O’Reilly.

Data Availability Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.


  • Deprescribing
  • Care homes
  • Pharmacist
  • Implementation
  • Primary care
  • Older people medication


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