Deprescribing Clinical Trial
Official title:
Efficacy and Feasibility of De-prescribing Rounds in a Singapore Rehabilitative Hospital- a Pilot Randomized Controlled Trial
This open-labelled randomized control trial will be conducted in a Singapore Rehabilitation Hospital to investigate the efficacy, cost-reduction, safety and feasibility of a weekly deprescribing multi-disciplinary inpatient deprescribing round up to 28 days post discharge.
ABSTRACT BACKGROUND: Deprescribing has been effective and safe in reducing polypharmacy and
morbidity (e.g. fall), especially amongst elderly. However, little has been studied about the
efficacy of a regular multidisciplinary round in deprescribing predefined medications in
Singapore rehabilitative hospitals.
AIM: This study aims to evaluating the effects of a weekly multidisciplinary team(MDT)
de-prescribing round on the reduction on total daily dose, cost of medications, its safety
and feasibility in a Singapore rehabilitative hospital.
Methods: A total of 260 newly admitted patients will be randomised to a de-prescribing
intervention (n= 130) or control (usual care) group (n= 130), using GraphPad randomization
sequence software ©2017. The 5 steps of deprescribing process will be used and the targets of
deprescribing are Beer's list of potentially inappropriate medications (AGS 2015 version),
predetermined supplements and symptomatic medications. Predetermined medications were
deprescribed following initial MDT assessment, discussion with attending doctors and
consideration of patients' preferences regarding discontinuation or dose reduction. Total
daily dose reduction, cost and side effects of deprescribing were monitored on admission day
14, 28, discharge day and post-discharge day 28. Time required for such rounds are also
measured.
IMPACT: Once proven successful, this effective model of deprescribing could safely help to
cut down caregiver's medicine administrative burden, improve compliance and reduce national
healthcare cost. This model could also be easily replicated in all Singapore rehabilitative
hospitals.
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