Aged Clinical Trial
— MedSaferOfficial title:
Reducing Post-discharge Potentially Inappropriate Medications Among Older Adults: a Multi-centre Electronic Deprescribing Intervention
Verified date | April 2018 |
Source | McGill University Health Center |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Potentially inappropriate medications (PIMs) can lead to adverse drug events (ADEs) among older adults and especially those classified as frail. ADEs are responsible for nearly 27,000 hospital admissions in Canada annually. Within 30 days of discharge, medications contribute to two-thirds of adverse events, with nearly 60% being preventable or ameliorable. MedSafer is software product that guides patients and physicians in the community through the process of deprescribing. MedSafer electronically cross-references patient comorbidities with the most recent evidence-based PIMs, as of the study date, in order to generate a patient-tailored deprescribing care plan. This study will evaluate whether this application, when applied at hospitalization, leads to a reduction in the proprotion of patients with PIMs prescribed at discharge, by highlighting harmful medications for deprescription to treating physicians. This study will take place on the clinical teaching units (CTUs) at four hospitals. Based on historical records, the investigators estimate enrolling 480 patients aged 65 or older over three months. A trained research assistant will identify eligible patients, and will enter their medications, comorbidities, and an estimate of frailty into MedSafer. A deprescribing plan will be generated for the CTU team containing rationale for suggested medication changes and strategies for safe and successful deprescription. The CTU team will then decide in conjunction with the patient or proxy, and with relevant consultants, which medications can rationally be stopped or tapered at discharge.
Status | Completed |
Enrollment | 924 |
Est. completion date | June 15, 2017 |
Est. primary completion date | May 15, 2017 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 65 Years to 120 Years |
Eligibility |
Inclusion Criteria: Participants will represent a consecutive series of persons. - Eligible participants include those who are: - aged 65 years or older; - taking 5 or more medications; and - admitted to the inpatient medical ward at any of the study sites. - Patients who are cognitively impaired or otherwise unable to provide consent will still be included as this sub-population of patients may be at greatest risk of ADEs because of their communication problems. Tri-council ethics guidelines (Canada) deem that this sub-population should not be excluded from interventions that potentially provide direct benefit to the participant due to the inability to provide informed consent (Article 4.5, Tri-Council Policy Statement 2008). For these patients, the family/proxy will authorize study participation pending the return of patient capacity to consent. Patients who are ultimately discharged from non-study units during their hospitalization will be excluded unless that unit is a transitional care, rehabilitation, or post-acute care unit used to bridge the gap between acute medical hospitalization and community services. Exclusion Criteria: - patients expected to be transferred to another acute care hospital, a non-medical unit, or a palliative care unit; - patients who normally live outside of the province of hospitalization; - patients not enrolled in (or eligible for) the provincial drug plans; - patients previously enrolled in the study; - patients or proxy not able to speak English or French; - no means of contacting patient or proxy post-discharge; - patients expected to die within 30 days and whose level of care has been declared to be palliative will be maintained in the study but will be excluded from select secondary outcomes. |
Country | Name | City | State |
---|---|---|---|
Canada | McGill University Health Centre (Royal Victoria Hospital and Montreal General Hospital) | Montreal | Quebec |
Lead Sponsor | Collaborator |
---|---|
McGill University Health Center | The Ottawa Hospital, University Health Network, Toronto |
Canada,
Gallagher PF, O'Connor MN, O'Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther. 2011 Jun;89(6):845-54. doi: 10.1038/clpt.2011.44. Epub 2011 Apr 20. — View Citation
Interagency_Advisory_Panel_on_Research_Ethics. Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Ottawa: Interagency Secretariat on Research Ethics; 2008.
Lee TC, Frenette C, Jayaraman D, Green L, Pilote L. Antibiotic self-stewardship: trainee-led structured antibiotic time-outs to improve antimicrobial use. Ann Intern Med. 2014 Nov 18;161(10 Suppl):S53-8. doi: 10.7326/M13-3016. — View Citation
McDonald EG, Jones J, Green L, Jayaraman D, Lee TC. Reduction of inappropriate exit prescriptions for proton pump inhibitors: A before-after study using education paired with a web-based quality-improvement tool. J Hosp Med. 2015 May;10(5):281-6. doi: 10.1002/jhm.2330. Epub 2015 Feb 24. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Proportion of Patients with cessation of Potentially Inappropriate Medications (PIMs) | The primary outcome is the proportion of patients with 1 or more PIM discontinued at discharge | Proportion will be evaluated on the day of the patient's discharge from the hospital | |
Secondary | The number of medications prescribed at discharge and 30 days post | The absolute number of medications prescribed at discharge and at 30 days post hospital discharge as compared to at admission | Within 30 days after the patient was discharged from the hospital | |
Secondary | Adverse drug event | An ADE is defined as an injury resulting from medical intervention related to a drug. ADEs will be assessed by trained clinician reviewers using the Leap-Bates method | Within 30 days after the patient was discharged from the hospital | |
Secondary | Adverse event | An adverse event is defined as an unplanned utilization of healthcare services, a death, and/or a new or worsening symptom concerning to the patient for which they intend to seek medical care | Within 30 days after the patient was discharged from the hospital | |
Secondary | Health related quality of life | This will be assessed using the EQ-5D-5L Health Questionnaire. | At 30 days after the patient was discharged from the hospital | |
Secondary | Length of stay (days) | Determination of hospital length of stay from enrollment into the study to discharge. | Duration of patient's hospital stay, from admission to discharge up to a maximum of 90 days | |
Secondary | Return to the emergency department | Determination of whether participant returned to the emergency department after hospital discharge within 30 days of initial discharge. | At 30 days after the patient was discharged from the hospital | |
Secondary | In-hospital mortality | In-hospital mortality during the index hospital admission. | Throughout the index admission from time patient admitted to time patient discharged up to a maximum of 90 days | |
Secondary | In hospital falls | Falls that are recorded while the patient is hospitalized | During patient's index admission, evaluated from admission to discharge, up to a maximum of 90 days | |
Secondary | 30-day all cause mortality | Patients who die within 30 days of hospital discharge | At 30 days post hospital discharge | |
Secondary | Proportion of potentially inappropriate medications at 30-days post discharge | Proportion of PIMs at 30-days post discharge as compared to proportion of PIMs at admission and at discharge | At 30 days post discharge |
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