Nobody ever questions—Polypharmacy in care homes: A mixed methods evaluation of a multidisciplinary medicines optimisation initiative

Sue Jordan; Hayley Prout; Neil Carter; John Dicomidis; Jamie Hayes; Jeffrey Round; Andrew Carson-Stevens

doi:10.1371/journal.pone.0244519

Peer Review History

Original SubmissionOctober 16, 2020
16 Nov 2020 Decision Letter - Mojtaba Vaismoradi, Editor PONE-D-20-32601 Nobody ever questions – polypharmacy in care homes: a mixed methods evaluation of a multidisciplinary medicines optimisation initiative PLOS ONE Dear Dr. Jordan, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Dec 28 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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We will update your Data Availability statement on your behalf to reflect the information you provide. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: Dear authors I would like to thank you for giving me the opportunity to review this high-quality manuscript. This work is well designed and well written manuscript that improve patient’s safety in home care using the involve of nurses in the Adverse Drug Reaction Profile for polypharmacy. I have some few comments: In introduction- can you give more literature about using of ADRe-p in health care professions particularly in nurses. In methods- line 125: please enter the full name of the abbreviation. Line 142: Is there range for polypharmacy?? In the introduction you report a statistic about polypharmacy in which > 4 was used for polypharmacy. Why you used >3 for polypharmacy? please provide more clarification. What is difference between Line 142 as a inclusion criteria and line 147 as a exclusion criteria?? In my opinion both of them are same. Please use only a definite inclusion criterion for this item. In results- Figure 2a and 2b: arrows are crooked. Reviewer #2: Thank you for the opportunity to review this study. The structure of the manuscript is well put together and it is written up clearly. The only challenge to the manuscript is that it needs a bit of revising for punctuation, inclusion criteria, and discussion section. - Please, pay attention to punctuation. For instance in lines 268,284 and so on. - Inclusion criteria: state rationale for why you chose >3 prescribed medicines daily. - Please, at the first paragraph, describe the aim of the study. Then, discuss your results. [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0244519.r001
Revision 1
3 Dec 2020 Author Response Response to reviewers Nobody ever questions – polypharmacy in care homes: a mixed methods evaluation of a multidisciplinary medicines optimisation initiative Short title: The adverse drug reaction profile for polypharmacy Rebuttal letter / response to reviewers [PONE-D-20-32601] - [EMID:148862874e6b707a] 24.11.20 Dear Professor Vaismoradi, Thank you for the return of our manuscript. We are very grateful for the reviewers’ support and suggestions. We have done our best to comply, as tabulated below. We feel that clinicians need to be aware of the importance of monitoring patients for any adverse effects of prescribed medicines. Publication in PlosOne would stimulate prescribers to take a proactive approach to medication review for people in long-term care. We hope that readers will concur with the reviewers: The work has not been submitted elsewhere. Thank you for your time spent on this paper. Yours, Sue Jordan, on behalf of all authors Changes Made We have tracked in the text where we have made the suggested changes. The paper has been submitted with and without tracks. Journal Requirements: 1.) Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf We have done our best to comply. We are unaware of any outstanding issues, but are happy to modify if required. 2.) Please include additional information regarding the interview guide or script used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a guide as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information. This has been appended as supplementary material, S3 file. 3.)We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. The Data Availability Statement now reads: Data are provided within the supplementary tables. Ethical restrictions have been imposed on data sharing by the NHS Research Ethics Committee that approved this study. The data contain potentially identifying and sensitive information. The data used in this study are available to the research data community at https://zenodo.org/record/4090384#.X4hKptZFzLZ Swansea University, Swansea, UK. All proposals to view the data are subject to review by Swansea University’s Research Governance department and the PI. Before any data can be accessed, approval must be given. The application process is via the Academic Lead for Research Integrity Research Engagement & Innovation Services, Swansea University and the PI or Neil Carter. Contacts: Swansea University, Swansea SA2 8PP • Tel: +44 /0 1792 606060 and 518541 or 295610 • Email: researchgovernance@swansea.ac.uk, s.e.jordan@swansea.ac.uk or n.carter@swansea.ac.uk The research instrument used in the study is available for clinical use without charge via the project website: http://www.swansea.ac.uk/adre/ b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Our data are restricted, as above. Response to reviewers We are very grateful for the detailed consideration given to our paper, and have responded to the points raised below. Reviewer #1: Dear authors, I would like to thank you for giving me the opportunity to review this high-quality manuscript. This work is well designed and well written manuscript that improve patient’s safety in home care using the involve of nurses in the Adverse Drug Reaction Profile for polypharmacy. I have some few comments: Thank you for your support. In introduction- can you give more literature about using of ADRe-p in health care professions particularly in nurses. We have moved and added some text on this to the introduction, last sentence: Our intervention, the ADRe Profile [2-4], achieves this by uniting the tacit, experiential knowledge of nurses and carers with records of the patients’ clinical problems and possible causes, in a form that can be shared within the multidisciplinary team [2-7] (Fig 1). This entails moving Fig 1. In methods- line 125: please enter the full name of the abbreviation. Standards for Quality Improvement Reporting Excellence – done Line 142: Is there range for polypharmacy?? In the introduction you report a statistic about polypharmacy in which > 4 was used for polypharmacy. Why you used >3 for polypharmacy? please provide more clarification. Definitions differ. We explain in the inclusion criteria: This definition of polypharmacy is used by Cochrane reviewers [27]. We were unable to adopt definitions based on appropriateness or duration of prescriptions before gaining consent to view records. What is difference between Line 142 as a inclusion criteria and line 147 as a exclusion criteria?? In my opinion both of them are same. Please use only a definite inclusion criterion for this item. The line is deleted – thank you. In results- Figure 2a and 2b: arrows are crooked. The figures have been redrawn and new tif files uploaded. Reviewer #2: Thank you for the opportunity to review this study. The structure of the manuscript is well put together and it is written up clearly. The only challenge to the manuscript is that it needs a bit of revising for punctuation, inclusion criteria, and discussion section. Thank you - Please, pay attention to punctuation. For instance in lines 268,284 and so on. Line 268, now 269, ‘and’ has been substituted for ‘or’. Line 284 – no errors identified. Line 455, now 468 – full stop substituted for semicolon Line 458, now 459 – definite article removed Line 460, now 464 – ‘however’ substituted for ‘but’ Arabic numerals replaced with text throughout. - Inclusion criteria: state rationale for why you chose >3 prescribed medicines daily. We added this statement, as above: This definition of polypharmacy is used by Cochrane reviewers [27]. We were unable to adopt definitions based on appropriateness or duration of prescriptions before gaining consent to view records. - Please, at the first paragraph, describe the aim of the study. We have added to start of discussion: We aimed to identify changes following nurses’, carers’ and pharmacists’ use of ADRe-p. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0244519.r002
11 Dec 2020 Decision Letter - Mojtaba Vaismoradi, Editor Nobody ever questions – polypharmacy in care homes: a mixed methods evaluation of a multidisciplinary medicines optimisation initiative PONE-D-20-32601R1 Dear Dr. Jordan, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Prof, Mojtaba Vaismoradi, PhD, MScN, BScN Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0244519.r003
Formally Accepted
21 Dec 2020 Acceptance Letter - Mojtaba Vaismoradi, Editor PONE-D-20-32601R1 Nobody ever questions – polypharmacy in care homes: a mixed methods evaluation of a multidisciplinary medicines optimisation initiative Dear Dr. Jordan: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Mojtaba Vaismoradi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0244519.r004

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