Creating Awareness of preScribing Cascades and Managing Adverse Drug Effects (CASC-ADE) Tool: Appraisal by Future End Users

Despite increasing attention for prescribing cascades, healthcare providers (HCP) need tools for taking action. We developed a tool, comprising fact sheets that summarise background information and provide guidance for recognising, managing, and preventing specific prescribing cascades. The aim of this study was to explore end users’ appraisal of the initial version of this ‘Creating Awareness of prescribing Cascades and managing Adverse Drug Effects’ (CASC-ADE) tool. A cross-sectional study was conducted using an online questionnaire including 15 items (13 scored on 7-point Likert scales, 2 on a 7-point bipolar scale, with a score of 4 being adequate), covering four domains: purpose, rigour, usability, and usefulness. The questionnaire, alongside at least one fact sheet, was sent to a convenience sample of HCPs, medical and pharmacy students. Suggestions for improvement could be made by respondents. Descriptive statistics were evaluated separately for HCPs and students. The study included 17 HCPs (9 pharmacists, 8 clinicians) and 12 students (6 pharmacy, 6 medical). All items received positive median scores: Likert scale items between 5 and 7 for HCPs and 5 and 6 for students, and bipolar scale items 4 for HCPs and 4–4.5 for students. Highest scores were seen for purpose, usability, and usefulness for recognising prescribing cascades (median 6–7). Usefulness for managing and preventing prescribing cascades received slightly lower scores (median 5–6). Fifteen HCPs and nine students were positive about using the tool in practice but some mentioned this would depend on its practical implementation. A few respondents suggested including more specific guidance for taking action. The initial CASC-ADE tool was positively appraised across the assessed domains by the HCPs and students. Further research is needed to assess whether its use will improve recognition, management and prevention of prescribing cascades.