Medicines optimisation at care transitions for people living with Dementia: A qualitative systematic review of patient, carer and healthcare professional perspectives.

Scientific Summary Background A James Lind Alliance (JLA) Priority Setting Partnership (PSP) exercise conducted in Australia on the topic “Quality Use of Medicines in People Living with Dementia” resulted in a list of the top 10 priorities for research around use of medicines in people living with dementia. The National Institute of Health and Care Research Evidence Synthesis Programme (NIHR-ESP) was asked by the JLA to address one of these priorities, with the specific question being: “How can communication between healthcare professionals about medicines be optimised, especially at transitions of care, to achieve multi-disciplinary care for people living with dementia (PLWD)?” Aims The overall aim of the qualitative evidence synthesis is to identify and synthesise the views of patients, carers and healthcare professionals on the factors that facilitate or impede medicines optimisation at transitions of care. This will allow a deeper understanding of how medicines optimisation works at transitions of care and allow policy makers and practitioners a greater understanding of how models of care or specific interventions or tools could facilitate this. Research questions 1) What are the views of patients and carers (both paid and unpaid) about the factors that influence medicines optimisation at transitions of care for PLWD? 2) What are the views of healthcare professionals about the factors that influence medicines optimisation at transitions of care for PLWD? 3) What is the perceived impact on PLWD, healthcare professionals and carers when medicines are not managed/optimised at transitions of care? 4) Is there evidence relating to communication as a factor that impacts on medicines optimisation at transitions of care? 5) Can we map evidence on factors that influence medications optimisation onto existing frameworks of transitions of care? Method Following a structured database search, screening and data extraction, we will utilise a framework synthesis approach - best fit framework synthesis (Carroll et al 2013). This will ensure a rich exploration of the views of the different stakeholder groups. Database search A comprehensive search will be conducted to identify relevant peer-reviewed and grey literature pertaining to care transitions in care for people with dementia. The search will encompass the period between 2015 and 2025 (current), which reflects the last decade of research and practice and changes in practice such as the move from paper records to electronic health records. This timeframe was chosen in order to capture the recent advancements in dementia care, including models of patient centred care and responses to the increasing prevalence of dementia among older adults (Alzheimers Society, 2014). We will search the following databases: MEDLINE, Embase, PsycInfo, CINAHL, Cochrane Library, Social Science Citation Index (SSCI). Grey literature will be identified through searches of Google Scholar, relevant organisational websites (e.g. Alzheimer's Association, World Health Organization, Alzheimer's Society), and policy document repositories (e.g., BASE). An example search strategy for MEDLINE (via Ovid) is presented below. The search strategy will utilise a combination of controlled vocabulary and keyword combination related to the concepts of ‘care transition’ and ‘dementia’. The search strategy will be iteratively refined based on initial search results and feedback. All search results will be imported into the EndNote reference management software for deduplication. Ovid MEDLINE(R) Example Search Strategy 1 - exp Dementia/ or (dementia* or alzheimer*).ti,ab,tw. 2 - Transitional Care/ or ((transition* or transfer*) adj3 care).ti,ab,tw. or (hand-off or handover).ti,ab,tw. or "Continuity of Patient Care"/ 3 - Communication/ or Interdisciplinary Communication/ or Interprofessional Communication/ or (inter-setting or interprofession*).ti,ab,tw. or (communicat* or dicuss* or decid* or decision* or consensu* or agree* or disagree* or convers*).ti,ab,tw. 4 -2 and 3 5 - 1 and 4 6 - Medication Adherence/ or Inappropriate Prescribing/ or Deprescriptions/ or (medicine* or medicat* or prescrib* or treat* or deprescrib*).ti,ab,tw. 7 - 5 and 6 Screening An initial set of 100 references will be used as a pilot set and independently screened by two experienced reviewers to ensure consistency in the application of these criteria. The reviewers will then convene to discuss any discrepancies in the application of these criteria. The remaining (non-pilot) reference screening will be undertaken by two reviewers independently and any discrepancies discussed and if needed, referred to a third reviewer. All references screened for inclusion at title and abstract stage will be screened at full text. Extraction We will extract study characteristics data from included studies into Covidence - a web-based collaboration software platform that streamlines the production of systematic and other literature reviews. We will use Nvivo to code the following fields in line with Houghton et al (2016) - Main findings - themes presented etc, Frameworks or theories used (where appropriate), Limitations/applicability to a UK context and Author conclusions. Synthesis To synthesise data extracted, we will utilise a framework synthesis approach - best fit framework synthesis (Carroll et al 2013). This will ensure a rich exploration of the views of the different stakeholder groups. The benefits of using a framework for the synthesis of this data are that it will allow rapid and consistent data extraction and synthesis which will underline the methodological strength of this approach (Brunton et al 2020). The initial framework will be presented in the final outputs, alongside any modifications made through the synthesis process to allow the readers to understand how and why amendments were made. Quality Assessment We will use the CochrAne qualitative Methodological LimitatiOns Tool (CAMELOT), a new domain based tool for assessing methodological limitations in primary qualitative studies (Munthe-Kaas et al 2024). Expert input We will utilise our overall centre PPIE group to recruit a PPIEgroup for this review. We will use an equality of opportunity approach for this group of patients and carers. Where needed training will be offered. We will also link in with University and Health service colleagues as experts. EDI We take EDI considerations seriously and have developed an internal tool SEEDI (Sheffield EnSyN Equality, Diversity and Inclusion). Outputs We anticipate that the findings of the review will be reported in two journal articles and where appropriate we will use peer reviewed reporting guidelines. The JLA have indicated that they will use the findings of the review to consider the feasibility of a grant application to explore the development of an intervention based on the findings of this review.