OPERA 2024: Sion Scott

Not many people can say that an intervention they developed during their PhD is being trialled in 24 hospitals across England as part of a study involving 22,000 patients. However, that is exactly the position that Sion Scott has found himself in with the comprehensive geriatrician-led medication review (CHARMER) research project, for which he is co-investigator and programme manager.

CHARMER is a five-year England-wide research project, which started in 2020, to develop and test an approach to initiating more discussions with older patients in hospitals around stopping medicines that are no longer useful and could be causing harm — so-called ‘proactive deprescribing’.

Sion completed his MPharm degree in 2015 and, after initially practising in hospital pharmacy, went on to complete a PhD in behavioural science in 2019 at the University of East Anglia. Sion currently practices one day per week as a hospital pharmacist in geriatric medicine and the remainder as a lecturer in behavioural medicine at the University of Leicester.

With two research focuses on medicines and medicines optimisation, Sion draws on his expertise as both a pharmacist and a behavioural scientist to understand how to most effectively support patients in making beneficial changes to the way they view and use medicines. Other areas of focus include increasing vaccine uptake in the care home population and improving cancer screening.

Much of Sion’s research involves older people, an interest that was sparked as a junior pharmacist when undertaking drug histories with these patients.

“I was seeing all these medicines that they were taking, and that we would send them home on that same list of medicines, with probably another five medicines added to it. I was thinking, we’re not checking that this is all OK, that this is still safe for them, and that really bothered me,” he said.

“What I’m trying to do with my research is make sure that what happens is good quality use of medicines. Sometimes that means taking less medicines and I think the impact of that in this population is probably greatest.”

Sion’s progression into pharmacy research was not something he initially planned and it was a summer research placement with an academic pharmacist, where he saw first hand the capacity research has to change and improve practice, that sparked his interest. “It showed the kind of research that we do as applied health researchers can really have an impact at the coalface and, in quite a short period of time, we could change practice quite quickly,” he said.

Sion’s work is already influencing government policy, with recommendations from his research embedded in the government’s response to the 2021 National Overprescribing Review. Sion also worked on translating the deprescribing aspect of findings from a care home’s independent pharmacist prescribing trial into policy.

“I convened a policy working group. We had the four chief pharmaceutical officers’ teams there, we had the director of the NHS older people’s medicine department. There were also patients, carers and third sector organisations, and people from the [Department of Health and Social Care] who were responsible for implementing the findings of the national overprescribing review.”

Sion’s research also has demonstrable international reach. As part of his PhD, Sion developed an implementation framework for deprescribing interventions in hospitals. The work, published in Age and Ageing in November 2019, has been cited more than 60 times, with a group in Switzerland using it to design their own hospital deprescribing intervention and another in Australia adapting it for the primary care system. “It’s been cited not just as a background reference in the discussion, people are using it as a blueprint to design their own intervention,” Sion explains.

He is passionate about building research capacity in pharmacy and is the early-career researcher lead for the National Institute for Health and Care Research (NIHR) national pharmacy incubator, which aims to do just that. His collaboration also extends across Europe: he is a founding member of the Network of European Researchers in Deprescribing (NERD), which is a collaboration of more than 500 deprescribing researchers from 30 European countries. As part of his role in NERD, Sion co-led a successful funding application to the journal Basic & Clinical Pharmacology & Toxicology to convene the first international deprescribing conference in 2022. The conference drew attendees from across the globe and, following its success, the second International Conference on Deprescribing is scheduled to convene later this year in France.

Publications

Sud D, Anandaram A, Atkins H, McAskill R & Scott S. Utilisation of Health Technologies for Physical Health of People with Learning Disabilities: Point of Care Testing. J Psychosoc Rehabil Ment Health 2023;10:451–63. doi: 10.1007/s40737-023-00362-3

Aryankhesal A, Blake J, Wong G et al. Sleep disturbance in dementia or mild cognitive impairment: a realist review of general practice. Br J Gen Pract 2024;74(741):e233–41. doi: 10.3399/BJGP.2023.0171

Scott S, Atkins A, Martin-Kerry J et al. CompreHensive geriAtRician-led MEdication Review (CHARMER): Protocol for a feasibility study of a hospital deprescribing behaviour change intervention. BMJ Open 2023;13(8):e075795. doi: 10.1136/bmjopen-2023-075795

Alsaif F, Twigg M, Scott S et al. A systematic review of barriers and enablers associated with uptake of influenza vaccine among care home staff. Vaccine 2023;41(42):6156-6173. doi: 10.1016/j.vaccine.2023.08.082

Scott S. Unveiling the latest deprescribing research: a new themed collection. International Journal of Pharmacy Practice 2023;31(3):267–8. doi: 10.1093/ijpp/riad031

Scott S, Martin-Kerry J & Bhattacharya D. Developing and testing complex behaviour change interventions to support proactive deprescribing: A narrative review. Basic Clin Pharmacol Toxicol 2023;133(6):669–72. doi: 10.1111/bcpt.13863

Scott S, Atkins B, Kellar I et al. Co-design of a behaviour change intervention to equip geriatricians and pharmacists to proactively deprescribe medicines that are no longer needed or are risky to continue in hospital. Res Social Adm Pharm 2023;19(5):707–16. doi: 10.1016/j.sapharm.2023.02.003

Smith C, Bhattacharya D & Scott S. Understanding how primary care practitioners can be supported to recognise, screen and initially diagnose oropharyngeal dysphagia: protocol for a behavioural science realist review. BMJ Open 2023;13(2):e065121. doi: 10.1136/bmjopen-2022-065121

Good E, Bhattacharya D & Scott S. What is known about the determinants of developing antipsychotic-induced metabolic syndrome and interventions to address them for community dwelling adults: a scoping review protocol. medRxiv 2023. doi: 10.1101/2023.01.05.22283663

Micallef C, Enoch DA, Kamranpour P et al. The role of hospital antimicrobial and infectious diseases pharmacists in the UK: a theoretically underpinned exploration. JAC Antimicrob Resist. 2023;5(1):dlac136. doi: 10.1093/jacamr/dlac136

Patel A, Sims E, Blacklock J et al. Cluster randomised control trial protocol for estimating the effectiveness and cost-effectiveness of a complex intervention to increase care home staff influenza vaccination rates compared to usual practice (FLUCARE). Trials 2022;23(1):989. doi: 10.1186/s13063-022-06925-2

Birt L, Wright DJ, Blacklock J et al. Enhancing deprescribing: A qualitative understanding of the complexities of pharmacist−led deprescribing in care homes. Health Soc Care Community 2022;30(6):e6521–31. doi: 10.1111/hsc.14099

Atkins B, Bhattacharya D, Smith C & S Scott. Barriers and enablers to switching from a solid to a liquid formulation of Parkinson’s medication: a theory-based mixed methods investigation. Int J Clin Pharm 2022;44(4):1046–56. doi: 10.1007/s11096-022-01446-z

Scott S. Deprescribing: a call for research that supports implementation in practice. International Journal of Pharmacy Practice 2021;29(6):525–6. doi: 10.1093/ijpp/riab074

Scott S, Wright DJ & Bhattacharya D. The role of behavioural science in changing deprescribing practice. Br J Clin Pharmacol 2021;87(1):39–41. doi: 10.1111/bcp.14595

Scott S, May H, Patel M, Wright DJ & Bhattacharya D. A practitioner behaviour change intervention for deprescribing in the hospital setting. Age Ageing 2021;50(2):581–6. doi: 10.1093/ageing/afaa169

Scott S, Twigg MJ, Clark A et al. Development of a hospital deprescribing implementation framework: a focus group study with geriatricians and pharmacists. Age Ageing 2020;49(1):102–10. doi: 10.1093/ageing/afz133

Scott S, Clark A, Farrow C et al. Attitudinal predictors of older peoples’ and caregivers’ desire to deprescribe in hospital. BMC Geriatr 2019;19(1):108. doi: 10.1186/s12877-019-1127-x

Scott S, Clark A, May H & Bhattacharya D. Validation and feasibility of the medication acceptability questionnaire to investigate tablet and liquid alendronic acid with older hospital patients. Pharmacy 2018;6(3):84. doi: 10.3390/pharmacy6030084

Scott S, Clark A, Farrow C et al. Deprescribing admission medication at a UK teaching hospital; a report on quantity and nature of activity. Int J Clin Pharm 2018;40(5):991–6. doi: 10.1007/s11096-018-0673-1

Seddon J, Friedrich C, Wadd S et al. Improving patient experience for people prescribed medicines with a risk of dependence or withdrawal: co-designed solutions using experience based co-design. BMC Prim Care 2024;25(1):17. doi: 10.1186/s12875-023-02253-9