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Coordinated_Research_Projects-(ARC)-Fundings

ldri | Bruxelles Woluwe

Di_Prescribe

ARC projects are large-scale collaborative research projects (48 to 60 months), aimed at developing inter-university centers, with a view to the economic and social valorization of research results.

In 2022, ARC financed the Di-Prescribe project.

Prescription of medications is a fundamental component of health care. However, inappropriate prescriptions and overuse of medications could increase the risk of negative health consequences. 

In particular, benzodiazepine receptor agonists (BZRA), used in case of insomnia or anxiety, are likely to be prescribed inappropriately. BZRA use is not recommended for more than 4 weeks, particularly among older adults who may experience various adverse effects such as higher risks of falls, hip fractures and cognitive impairment. As an example, 52% of nursing home residents are prescribed a BZRA for longer than 4 weeks in 99% of cases, despite the current guidelines.

Deprescription aims to address the global problem of medication overuse through the reduction of the doses or discontinuing one or more medication that are no longer necessary for the patient. Deprescribing BZRA in the elderly, living in nursing homes, but also in the community setting, is therefore a solution to their inappropriate use.

The research project DI-PRESCRIBE aims to advance knowledge of Deprescribing Implementation to decrease medication overuse in older people and improve health and quality of life. Specifically, the case of BZRA deprescribing will be investigated.

Some ground-breaking aspects of DI-PRESCRIBE are that it will consider:

  • All three levels of the health care system: patient/caregiver level, health care professionals’ level, and the organization/environment (i.e., system/policy) level
  • All three settings of care: ambulatory care, acute care, and long-term care

This research project also aims to address the current limitations in literature according to which implementation science should be used to increase the translation of deprescribing evidence into practice and policy. More specifically, implementation science provides a set of theories, models and frameworks to understand the reasons behind the success or failure of interventions, but also what could be done to improve their impact.

 

Anne Spinewine, Professor of clinical pharmacy

Anne Spinewine is professor of clinical pharmacy and leads the clinical pharmacy research group (CLIP), Louvain Drug Research Institute (LDRI), UCLouvain. She has extensive expertise in quantitative and qualitative research on the appropriateness of use of medications in older people, and in interdisciplinary and patient-centred approaches toward optimisation of medication use. As part of DI-PRESCRIBE project, Anne Spinewine will lead the work packages 1 and 3.  


 

 

 

Jean Macq, professor of public health  

Jean Macq is professor of public health at the faculty of public health and senior researcher at the Institute of Research Health and Society (IRSS), UCLouvain. Thus, he coordinates research and evaluation projects in the field of integrated care, interorganizational network analysis, chronic care and primary care organization. Over the last years, Jean Macq has coordinated national complex evaluations of healthcare reforms. As part of DI-PRESCRIBE project, Jean Macq will lead the work package 4.


 

 

 

 

Marie de Saint Hubert, professor of geriatric medicine 


Marie de Saint Hubert is geriatrician and professor of geriatric medicine at CHU UCLouvain Namur. She shares her time between clinical functions and research projects focusing on informal caregivers, end-of-life issues and early identification of frail older persons. As part of DI-PRESCRIBE project, Marie de Saint Hubert will lead the work package 1.


Stephan Van den Broucke, professor in psychological sciences

Stephan Van den Broucke is professor at the Faculty of Psychology and Educational Sciences and the Psychological Sciences Research Institute (IPSY), UCLouvain. His research focuses on preventive health behaviour change, health promotion, health literacy, chronic disease self-management and public health capacity building. He has been promoter or principal investigator of more than 30 contracted research projects, including several international and European-funded projects. As part of DI-PRESCRIBE project, Stephan Van den Broucke will lead the work package 2. 


 

Sandy Tubeuf,  professor in health economics  

 

Sandy Tubeuf is a professor in health economics at UCLouvain. She has led the economic evaluations alongside several landmarks clinical trials of complex interventions (e.g. mental health and public health interventions) in the UK. In DI-PRESCRIBE, she will provide expert advice on the health economic evaluation of the feasibility studies and the full evaluation of interventions’ efficacity as part of WP1. She co-supervises the work of the postdoctoral researchers.


Joséphine Aikpitanyi, Post-doctoral researcher

Josephine Aikpitanyi is a post-doctoral researcher at the Institute of Health Research and Society (IRSS), Faculty of Public Health, UCLouvain. As a member of the project DI-PRESCRIBE, she works with Sandy Tubeuf on the Health Economic component of WP1.  


Tina Chevallereau, Post-doctoral researcher

Tina Chevallereau has been a post-doctoral researcher at the Clinical Pharmacy research group (CLIP), Louvain Drug Research Institute (LDRI), UCLouvain, until September 2023. As a member of the project DI-PRESCRIBE, she has been participating to the process evaluation of the studies conducted in WP1 as well as to the realist evaluation conducted in WP4. Finally, she has been involved in the coordination aspects of the research project, in collaboration with Anne Spinewine.


Marine Jaeken, Post-doctoral researcher

Marine Jaeken joined the Clinical Pharmacy research group (CLIP), Louvain Drug Research Institute (LDRI), UCLouvain, as a post-doctoral researcher, from November 2023 to September 2024. As a DI-PRESCRIBE member, she contributed to the process evaluation of the studies conducted in WP1, as well as to the realist evaluation conducted in WP4,  following up on Tina’s work. She also participated in some coordination aspects of the research project, led by Anne Spinewine. 


Sara Alves Jorge, PhD Student  

Sara Alves Jorge is a PhD Student at the Institute of Research Health and Society (IRSS), UCLouvain. As a member of the project DI-PRESCRIBE, she aims to identify the factors that determine the willingness of patients and informal caregivers (i.e. partners, adult children, etc.) to engage or not to engage in deprescribing, through a systematic review of the literature. This work will lead to the development of a questionnaire and thus contribute to the work package 2.


Laudine Ackermans, PhD Student  

Pharmacist by training, Laudine Ackermans is a doctoral student in the Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), UCLouvain. Her work focuses on improving the deprescribing skills of future healthcare providers (doctors, pharmacists and nurses). As a DI-PRESCRIBE member, she is conducting work-package 3, which aims to create and evaluate, through implementation science, an innovative teaching tool to remove the barriers of deprescribing for healthcare students.  

Dominique Vanpee



Perrine Evrard, PhD Student

Perrine Evrard is  pharmacist by training. During her PhD at the Clinical Pharmacy research group (CLIP), Louvain Drug Research Institute (LDRI), UCLouvain, she focused benzodiazepines deprescribing in nursing homes. With insights from behavior-change theories, she developed an intervention towards benzodiazepines deprescribing, pilot-tested it in 6 nursing homes across French-speaking parts of Belgium. This work contributed to the DI-PRESCRIBE project as part of the work-package 1.


 

 

Catherine Pétein, PhD Student

Catherine Pétein is a nurse by background. Benzodiazepine deprescribing in community-dwelling older adults was the main topic of her PhD thesis conducted at the Clinical Pharmacy research group (CLIP), Louvain Drug Research Institute (LDRI), UCLouvain. Her work, related to the development of an intervention promoting benzodiazepine deprescribing in the community setting and to the evaluation of its feasibility contributed to the DI-PRESCRIBE project as part of work package 1. From October 2024, she is participating in the project as a post-doctoral researcher, following up on Tina’s and Marine’s work.

Work Package 1

As part of the WP1, our objective was to develop, implement and evaluate deprescribing theory-based interventions in clinical practice, in two settings of care (i.e., the ambulatory and nursing home setting). 

Particular attention was paid to fill the gaps and weaknesses in deprescribing implementation research and address current limitations (i.e., limited use of theory, lack of standard terminology, heterogeneous measurement of outcomes, lack of process evaluation).

Especially, the development of these interventions followed recent guidance and proceeded in several phases: 1) developing intervention, 2) assessing the feasibility of the interventions and evaluation design in pilot trials, 3) using case studies to refine hypotheses regarding context, mechanisms and outcomes within and across settings.  Finally, a full evaluation will be performed in a hybrid effectiveness-implementation trial.

The research process of these interventions also included stakeholders engagement as well as an economic evaluation. Stakeholders engagement consisted of collecting the point of views of patients’ and HCPs’ having a personal or professional interest for deprescription on the intervention. Economic evaluation aimed at analysing the costs (i.e., resource use) and consequences (i.e., health outcomes) of an intervention. The adoption of a societal perspective will help to answer questions that matter most to decision-makers.
 


Work Package 2

The second work package of this research project will explore how to enhance implementation of deprescription by investigating the determinants of patients’ and informal caregivers’ (i.e., spouses, adult children, etc.) willingness to engage in deprescription.

The second work package of this research project aims to explore how to enhance implementation of deprescription by investigating the determinants of patients’ and informal caregivers’ (i.e., spouses, adult children, etc.) willingness to engage in deprescription.

Current research findings indicate that positive and negative attitudes towards deprescribing often coexist. For instance, research found that among 11,049 participants, almost 88% of patients are willing to reduce their medication use following physician suggestions. However, individuals may say they are open to deprescribing but also report high satisfaction with their medications. Hence, the available tools to assess patients’ willingness to stop their medication have difficulties to predict patients’ effective deprescribing. 

Current questionnaires thus probably do not capture all determinants of patients’ willingness to engage in deprescription.  To this end, a systematic review was  conducted in order to identify the main determinants of patients’ and caregivers’ engagement in deprescription. Based on the results of this review, a questionnaire was developed and is currently administered for validation to a sample of patients and caregivers. In addition, a short version of this questionnaire will be developed to facilitate its administration in clinical practice.
 


Work Package 3

The third work package aims to address the lack of knowledge on how to improve the competencies of future HCPs (i.e., physicians, nurses and pharmacists) for deprescription.

Indeed, current research findings showed that despite a high awareness of polypharmacy, final year medicine and pharmacy students have a low confidence in deprescribing without senior support, unclear views on professional roles and low self-efficacy in developing and implementing a deprescription plan. Despite the lack of studies investigating such topic, these preliminary findings highlight the necessity to improve teaching methods related to deprescribing for all health professionals.  

For this purpose, barriers and enablers of deprescription were firstly investigated through questionnaires and interviews. Precisely, questionnaires investigated self-reported knowledge, skills and attitudes of students in medicine, pharmacy and nursing, whereas interviews examined faculty members’ perceptions regarding the current teaching as well as barriers and enablers to teaching deprescribing. This results will be used to design, implement and evaluate an innovative educational approach. 
 


Work Package 4

The fourth work package aims to explore the policy landscape in relation to deprescribing for older people, that is, how national and regional policies can be leveraged to generate real practice change.
 

There are increasing efforts to introduce policies at the national or regional system levels to support deprescription in order to promote opportunities for deprescribing to take place while limiting the risk of unintended and negative consequences. However, studies investigating the implementation and outcomes of these policies remain scarce. A better understanding of how these approaches impact the implementation of deprescribing is thus required.

To this end, a rapid realist review is currently being performed on key policies that aimed to facilitate deprescribing for older people in Belgium, in the three settings of care (i.e., home, nursing home, and hospital). This will inform on plausible mechanisms that could explain why some policies work or not in Belgium. Following the identification of potential mechanisms, these will be discussed with policy makers and evaluated. Such a process will help us to translate our results into key recommendations for both policymakers and stakeholders in order to increase implementation of deprescribing in clinical practice.
 

 

The scientific symposium offered a unique opportunity to network about the implementation of deprescribing within the Belgian community.  

It took place on September 12th, 2024 from 9.30 AM until 4.30 PM at Auditoire Central D Maisin, Avenue E. Mounier 51, 1200 Brussels.

The program is available here.

DI-PRESCRIBE is funded through an Actions de Recherche Concertées (DI-PRESCRIBE project; 22/27-124); and is also partially funded by EBPpracticenet (Projet d’implémentation EBPpracticenet 2023); and by a research credit from the fond national de recherche scientifique (FNRS) (CDR40013898).

 

2025

  1. Alves Jorge S, Van den Broucke S, Koumba Maguena RJ, Spinewine A. Behavioral Determinants of Older Adults' and Caregivers' Willingness to Deprescribe: A Systematic Review. Public Health Nurs. 2025 Mar-Apr;42(2):1084-1114. doi: 10.1111/phn.13516. Epub 2024 Dec 30. PMID: 39740058; PMCID: PMC11895417.
    https://onlinelibrary.wiley.com/doi/10.1111/phn.13516 

  2. Macq J, López-Toribio M, Spinewine A. How can policies impact the relational process of deprescription? A realist review protocol with an initial theory. Front Public Health. 2025 Apr 16;13:1536147. doi: 10.3389/fpubh.2025.1536147. PMID: 40308915; PMCID: PMC12041054.
    https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1536147/full 

  3. Pétein C, Chevallereau T, Aikpitanyi J, Evrard P, Tubeuf S, Henrard S, Spinewine A. Protocol to evaluate the feasibility of the D-PRESCRIBE intervention adapted to the Belgian community setting (END-IT CS study). BMJ Open. 2025 Mar 4;15(3):e085434. doi: 10.1136/bmjopen-2024-085434. PMID: 40037665; PMCID: PMC11891543.
    https://bmjopen.bmj.com/content/15/3/e085434.long 

2024

  1. Evrard P, Chevallereau T, Aikpitanyi J, Pétein C, Tubeuf S, Henrard S, Spinewine A. Feasibility of a theory-based intervention towards benzodiazepine deprescribing in Belgian nursing homes: protocol of the END-IT NH cluster-randomised controlled trial. BMJ Open. 2024 Oct 22;14(10):e085435. doi: 10.1136/bmjopen-2024-085435. PMID: 39438099; PMCID: PMC11499836.
    https://bmjopen.bmj.com/content/14/10/e085435.abstract