Polypharmacy Clinical Trial
Official title:
Bundled Hyperpolypharmacy Deprescribing: Implementation and Evaluation of a System-wide Quality Improvement Intervention
Verified date | December 2023 |
Source | Kaiser Permanente |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Older patients using many prescription drugs (hyperpolypharmacy) may be at increased risk of adverse drug effects. This randomized controlled trial tested the effectiveness and safety of a quality intervention intended to reduce hyperpolypharmacy. The study was set at Kaiser Permanente Northern California, an integrated health system with multiple pre-existing deprescribing workflows. Eligible patients were aged ≥76 years using ≥10 prescription medications. The intervention included physician-pharmacist collaborative drug therapy management, standard-of-care practice recommendations, shared decision-making, and deprescribing protocols administered by telephone over multiple cycles for a maximum of 180 days after allocation. A priori primary effectiveness endpoints included change in the number of medications and in the prevalence of geriatric syndrome from 181-365 days after allocation. Second endpoints included utilization and adverse drug withdrawal effects. Information was obtained from the electronic health record.
Status | Completed |
Enrollment | 2471 |
Est. completion date | May 24, 2023 |
Est. primary completion date | July 29, 2022 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 76 Years and older |
Eligibility | Inclusion Criteria: - Kaiser Permanente patients - Age =76 years - =10 drugs (excluding topicals) where - drug filled =2 times in the past year and - drug last filled < 180 days ago Exclusion Criteria: - less than 12 months preceding enrollment at Kaiser Permanente - no primary care practitioner assigned - on dialysis - history of heart, liver, lung, breast, or bone marrow transplant - in hospice - under active treatment for cancer during the past 12 months - has received an intervention through the Pharmacy Targeted Deprescribing Program in the preceding year. |
Country | Name | City | State |
---|---|---|---|
United States | Kaiser Permanente Division of Research | Oakland | California |
Lead Sponsor | Collaborator |
---|---|
Kaiser Permanente |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Adverse drug withdrawal effects | Change in prevalence of lower respiratory, cardiovascular, gastrointestinal, hyperuricemia, and elevated blood glucose | Difference between (days 181-365 after randomization) and (180 days before randomization) | |
Primary | Change in prevalence of geriatric syndrome | Change in prevalence for any of the following: Falls (hip fracture, lower leg fracture, osteoporosis with fracture, pathologic fracture, osteonecrosis; gait; repeated falls; syncope; tripping; reduced mobility), Cognition (Somnolence; awareness; dizziness; malaise; Urinary incontinence (Unspecified urinary incontinence; retention of urine, unspecified; functional urinary incontinence; stress incontinence ; other specified urinary incontinence) and Pain (Drug induced headache; joint pain; muscle weakness, rhabdomyolysis, spas; myalgia) | Difference between (days 181-365 after randomization) and (180 days before randomization) | |
Primary | Change in number of medications | Change in number of dispensed medications recorded in the comprehensive, integrated pharmacy information system | Difference between (days 181-365 after randomization) and (180 days before randomization) | |
Secondary | Utilization | Change in number of outpatient visits, inpatient visits, and emergency department visits. | Difference between (days 181-365 after randomization) and (180 days before randomization) |
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