Deprescribing in a Long Term Care Facility

Polypharmacy Clinical Trial

Official title:

Impact of a Deprescribing Intervention on Nursing Home Residents: a Randomized Controlled Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03091153
• Other study ID #: HREB - 2016.312
• Status: Completed
• Phase: N/A
• Start date: March 30, 2017
• Est. completion date: June 1, 2019

Study information

• Verified date: July 2019
• Source: Memorial University of Newfoundland
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study will develop, implement and evaluate a deprescribing initiative at a Canadian Long Term Care (LTC) Facility. Residents currently undergo an annual medication review as part of the clinical pharmacy services provided in the LTC facility. For this study, eligible residents will be randomized to receive either a deprescribing focused medication review or usual care.

The deprescribing focused medication therapy assessments will be done on half of the 143 residents residing on the second and third floors of the facility. The other half of residents will serve as the control group and continue to receive their annual medication review and regular care from the attending physicians and nurses.

The deprescribing intervention will be delivered by final year pharmacy students completing their practice experiences, under the supervision of clinical pharmacists at the LTC facility and clinical pharmacists from Memorial University's Medication Therapy Services (MTS) Clinic. Currently the clinic has a well developed procedure for providing in depth medication therapy reviews for residents of the community, upon referral by their primary care physician. Students will adapt this model of medication review to have a stronger deprescribing focus and be applicable to elderly residents of a LTC facility. The intervention will consist of an in depth medication therapy review with a focus on identifying any medications that may no longer be required or are deemed to be inappropriate or potentially unsafe in the elderly based on currently guidelines/criteria. The students will work closely with members of the resident's care team on a daily basis, as well as the resident and their family, to develop and implement a deprescribing plan.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 67
• Est. completion date: June 1, 2019
• Est. primary completion date: December 31, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 65 Years and older

Eligibility

Inclusion Criteria (all of the following):

1. Over 65 years of age

2. Reside in St. Patrick's Mercy Home (2nd or 3rd floor units)

Exclusion Criteria (any of the following):

1. Do not take any regularly scheduled medications

2. Are receiving palliative care

3. Resident's physician or nursing team do not support participation

4. Resident or their substitute decision maker decline participation

Related Conditions & MeSH terms

• Polypharmacy

Intervention

Other:
• Medication Review
In depth medication review with a focus on deprescribing

Locations

Country	Name	City	State
Canada	St Patrick`s Mercy Home	St. John`s	Newfoundland and Labrador

Sponsors (2)

Lead Sponsor	Collaborator
Memorial University of Newfoundland	Eastern Health

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in number of medications taken daily by residents	Measured using facility medication logs and patient health records	3 and 6 months after receiving intervention
Secondary	All cause mortality rate	Measured using patient health records	3 and 6 months after receiving the intervention
Secondary	Instance of falls in the last 30 days	Measured using facility fall report logs	3 and 6 months after receiving the intervention
Secondary	Frequency of emergency room visits, unplanned hospital admission and/or unplanned GP visits	Measured using patient health records	3 and 6 months after receiving the intervention
Secondary	Cognitive function score	Measured using Cognitive Performance Scale (CPS) obtained from Resident Assessment Instrument (RAI) MDS 2.0	3 and 6 months after receiving the intervention
Secondary	Bowel function	Measured using bowel chart data for the 14 days prior to the assessment date	baseline, 3 and 6 months after receiving the intervention
Secondary	Independence in activities of daily living	Measured using the Activities of Daily Living Scale (ADL) obtained from RAI MDS 2.0	3 and 6 months after receiving the intervention
Secondary	Changes in general health	Measured using the Changes in Health, End-Stage Disease and Signs and Symptoms (CHESS) Score obtained from RAI MDS 2.0	3 and 6 months after receiving the intervention
Secondary	Social engagement	Measured using Index of Social Engagement (ISE) Score obtained from RAI MDS 2.0	3 and 6 months after receiving the intervention
Secondary	Aggressive behaviour	Measured using the Aggressive Behaviour Scale (ABS) obtained from RAI MDS 2.0	3 and 6 months after receiving the intervention
Secondary	Frequency of pain	Measured using the Pain Scale obtained from RAI MDS 2.0	3 and 6 months after receiving the intervention