A mixed methods case study realist evaluation of the WiserAD structured online support tool for antidepressant deprescribing in general practice: A study protocol (Preprint)

BACKGROUND Research suggests that the rapid increase in worldwide antidepressant use is mainly due to a rise in long-term and potentially inappropriate use. General practice patients who are no longer experiencing clinical benefit from their medication, should commence deprescribing. However this process is complex for both patients and clinicians and is not routinely occurring. Evidence based support for safe and successful antidepressant deprescribing is needed for patients and their doctor. OBJECTIVE This study aims to evaluate how the WiserAD approach to antidepressant deprescribing works, for whom and in what circumstances. METHODS A mixed methods case study realist evaluation will be conducted on participants in the WiserAD randomised controlled trial for antidepressant deprescribing. Up to 12 participants from the intervention and control arms will provide quantitative data at baseline and 3-month follow-up. Qualitative data from the same participants will be collected via narrative interview at 3-month follow-up. Quantitative and qualitative data will be converged to form a ‘case’ and analysis will be conducted within each case with comparisons made across multiple cases. RESULTS Recruitment of participants will commence in late 2022 and completed in early 2023. CONCLUSIONS To our knowledge, this will be the first realist evaluation of an antidepressant deprescribing intervention in primary care. Findings from this evaluation may assist in the implementation of antidepressant deprescribing in clinical practice. CLINICALTRIAL N/A