33Assessing Complexity in Interventions to Improve Appropriate Polypharmacy in Older People using the Intervention Complexity Assessment Tool for Systematic Reviews

Abstract

Background: A key challenge in prescribing for older multimorbid populations is ensuring appropriate polypharmacy. Most previously evaluated interventions targeting appropriate polypharmacy have involved multiple components and been described as complex interventions. The intervention Complexity Assessment Tool for Systematic Reviews (iCAT-SR) has been developed to facilitate detailed assessments of intervention complexity in systematic reviews. This study aimed to assess, using the iCAT-SR, the complexity of interventions aimed at improving appropriate polypharmacy in older people, as reported in studies (n = 20) included in the update of a Cochrane review Methods: Interventions were assessed independently by two authors using the six core iCAT-SR domains: (1) Active intervention components'; (2) 'Target behaviour/actions'; (3) Target organisational levels/categories'; (4) 'Degree of tailoring'; (5) 'Level of skill required by intervention deliverers'; (6) 'Level of skill required by intervention recipients'. Attempts were made to apply the tool's four optional domains: 'Interaction between intervention components'; 'Context/setting'; 'Recipient/provider factors'; 'Nature of causal pathway'. Disagreements were resolved by consensus discussion. Result(s): The findings demonstrate that interventions in this area often comprise multiple components and target behaviours. Intermediate to high level skills were typically required by those delivering and receiving the interventions. A lack of detailed reporting in study reports precluded consistent application of the iCAT-SR's optional domains. Conclusion(s): This study provides the first detailed assessment of complexity for interventions aimed at improving appropriate polypharmacy in older people. Further work is needed to determine if application of the iCAT-SR can help to determine whether varying levels of complexity impact on the effectiveness of interventions aimed at improving appropriate polypharmacy in older people.