Building Block #3: Implementation and evolution

TAPER-F

By 2016, the development of the TAPER structured clinical pathway was finalized and ready for wider testing. The TAPER-F trial, a feasibility RCT was the first iteration of the TAPER intervention to be tested for feasibility and signals of effectiveness. 

The objectives were:

  1. To see if TAPER would be feasible in a primary care setting
  2. To gain feedback from clinicians (pharmacists and prescribers), and to )understand what adjustments were needed to the clinical pathway itself. 
  3. To test the research tools needed to look at the effect on patient outcomes, for upscaling the intervention into a larger-scale randomized clinical trial. 

This trial, conducted between 2016 and 2017 found that implementing the TAPER pathway in day-to-day primary care clinical practice was not only possible, but also that almost all patient outcomes moved in a positive direction in those who had had the TAPER intervention. Additionally, many lessons were learned regarding how best to measure other important patient health outcomes (e.g. quality of life, comorbidity status, anxiety and depression, etc.). This study was used to inform design, implementation, and outcome measurement for the larger-scale RCT. 

Linking Recommendations to Patient Goals and Priorities

As part of the feasibility study, we assessed whether the approach we developed to making patient priorities visible in the pathway was useful. To do this, we investigated whether or not recommendations for medication changes being made during TAPER appointments by clinicians aligned with patient priorities that were recorded as part of the pathway – Had this been helpful in supporting the person focused approach patients said was needed? This study showed that patient functional goals and symptom priorities can be efficiently elicited during deprescribing conversations, and that a high proportion of medication recommendations did take patient preferences into account.

TAPER-RCT and other TAPER studies

Building on this several larger-scale trials of the TAPER structured clinical pathway in several different care settings are currently underway in Canada, Australia and New Zealand and are either complete or almost completed. Results from these studies will shed additional light on the extent to which the detailed negative consequences of polypharmacy (on things like mobility, thinking etc.) are actually reversible if unnecessary polypharmacy is reversed. This is important as it affects the timing at which any intervention or prevention should be considered. 

Links to TAPER studies recently or currently being conducted in other countries

Other papers and materials for Building Block #3