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Background/Aim: Medication-related adverse events, including gastrointestinal bleeding, pose a significant risk of hospitalization in patients with polypharmacy. However, interventions to improve medication safety are often difficult to implement in general practice because they do not adequately address the practical needs of both general practitioners (GPs) and patients. The aim of this study is to develop a feasible intervention for the prevention of hospitalizations due to gastrointestinal bleeding, using a participatory approach that involves relevant stakeholders, to ensure its suitability for implementation in routine practice.

Methods: The intervention development was based on a participatory, multi-stage research design involving GPs, medical assistants (MAs), pharmacists, specialist physicians, and patients. The process began with a literature review and an initial interprofessional workshop, where evidence-based interventions proven effective were discussed with regard to their implementability and selected for further development. Subsequently, qualitative interviews were conducted with representatives of the stakeholders groups to identify facilitators and barriers to implementation. Building on this, focus groups in the form of deliberative consultations (DCs) [1] were conducted to reach an informed consensus on the implementability of the intervention components and ways to enhance it. The DC methodology is based on principles of democratic deliberation, whereby all perspectives are taken into account and group dynamics are balanced through a two-phase design: deliberations in homogeneous professional groups (phase 1), followed by deliberation in a mixed group comprising representatives of the homogeneous groups (phase 2), with the goal of reaching common working agreements. Rapid qualitative thematic analysis [2] of the transcripts from the workshops, interviews, and deliberations was performed to iteratively select and refine the intervention components to optimize their feasibility based on the findings.

Results: Participating stakeholders, including patients, actively engaged in the various steps of the intervention development and provided constructive feedback, reflected in the content and design of the intervention components. Based on stakeholders´ feedback, the digital TARGET-ADE platform was created, containing a digital tool, study materials, patient brochures, and links to additional resources. The core intervention component is the digital TARGET-ADE tool for GPs. It provides algorithms for risk screening and clinical decision support, including general and medication group-specific recommendations for managing identified risks, as well as conversation guides to support shared decision making with patients about deprescribing and alternative treatments. The patient brochures available on the digital platform are printable educational materials designed to strengthen patients’ knowledge of the risks associated with medications that may cause gastrointestinal bleeding and relevant protective measures. Specific brochures address gastrointestinal bleeding, correct medication use, “sick day rules”, and general recommendations for safe medication use. The combination of digital and printable materials was considered optimal by all stakeholder groups.

Discussion/Conclusion: Successful prevention of hospitalizations requires strategies that can be implemented in routine healthcare. The participatory intervention development process, involving relevant stakeholders, helped to develop an intervention that the involved stakeholders considered feasible for implementation in routine care. The actual feasibility and acceptability of the digital tool and individual intervention components will be evaluated in a pilot study starting in autumn 2026 in general practices in Ostwestfalen-Lippe.

Literatur

[1] Rahimzadeh V, Longo C, Gagnon J, Fernandez C, Bartlett G. Assessing the quality of deliberative stakeholder consultations involving allied health profes-sionals in pediatric palliative care and hematology/oncology in Canada. BMC Palliat Care. 2021;20(1):189. DOI: 10.1186/s12904-021-00884-2
[2] Mathieson A, Elvey R, Wilson P. Development and application of a qualitative rapid analysis framework in a hybrid trial within primary care. BMJ Open. 2024;14(7):e076792. DOI: 10.1136/bmjopen-2023-076792