Polypharmacy Clinical Trial
— ALIGNOfficial title:
Align: Aligning Medications With What Matters Most
Verified date | May 2023 |
Source | Johns Hopkins University |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The Aligning Medications with What Matters Most (ALIGN) study will assess the feasibility and preliminary efficacy of a deprescribing intervention to reduce medication regimen complexity and treatment burden for people living with dementia (PLWD) and their care partners.
Status | Completed |
Enrollment | 138 |
Est. completion date | May 2, 2022 |
Est. primary completion date | May 2, 2022 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 65 Years and older |
Eligibility | Inclusion Criteria: - Age 65 or greater - Diagnosis of dementia from International Classification of Diseases (ICD) -9 or ICD-10 codes - At least one other chronic condition - Five or more chronic medications (to include all prescription and over-the-counter medications, both scheduled and as needed) - Have a primary care physician at the pilot clinic who has enrolled in the study; this will be defined as having had at least 1 previous visit with that physician Care partners: - Family or other companions age 21 years or greater who regularly help the patient with managing medications Exclusion Criteria: - As both the pilot and the planned pragmatic trial will be based in primary care, individuals residing in long term care facilities or enrolled in hospice will be excluded. - Individuals who cannot converse comfortably in English will be excluded because the FCMAHS has not been validated in other languages. |
Country | Name | City | State |
---|---|---|---|
United States | Kaiser Permanente | Aurora | Colorado |
United States | Johns Hopkins Bayview Medical Center | Baltimore | Maryland |
Lead Sponsor | Collaborator |
---|---|
Johns Hopkins University | Kaiser Permanente, National Institute on Aging (NIA) |
United States,
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Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Feasibility as Assessed by Proportion of Dyads That Opt Out of the Intervention | Dyads are comprised of the person living with dementia and their care partner. We will measure the proportion of dyads that opt out of the intervention versus the dyads that agree to participate. | A duration of approximately 8 months | |
Primary | Feasibility as Assessed by the Number of Pharmacist Messages to the Primary Care Provider (PCP) That Receive an Acknowledgment or Response | We will measure the number of pharmacist's messages that receive an acknowledgment or response from the PCP based on Electronic Medical Record (EMR) review | 3 months after enrollment | |
Primary | Feasibility as Assessed by the Number of Contacts Between Pharmacist and PCP | We will measure the number of contacts between pharmacist and PCP based on Electronic Medical Record (EMR) review | 3 months after enrollment | |
Primary | Feasibility as Assessed by the Number of Contacts Between Pharmacist and Dyad | We will measure the number of contacts between pharmacist and PCP and dyad based on Electronic Medical Record (EMR) review | 3 months after enrollment | |
Primary | Feasibility as Assessed by the Direct Time Required by the Pharmacist to Complete the Intervention | We will measure the amount of direct time that it takes the pharmacist to complete the intervention. We will access from pharmacist's documentation in the Electronic Medical Record (EMR). | 3 months after enrollment | |
Primary | Feasibility as Assessed by the Indirect Time Required by the Pharmacist to Complete the Intervention | We will measure the amount of indirect time that it takes the pharmacist to complete the intervention. We will access from pharmacist's documentation in the Electronic Medical Record (EMR). | 3 months after enrollment | |
Primary | Feasibility as Assessed by Percentage of Dyads Who Complete 2 of 2 Pharmacist Phone Calls Based on Documented Status Reports | Dyads are comprised of the person living with dementia and their care partner. We will measure the percentage of dyads who complete 2 of 2 pharmacist phone calls based on documented status reports | Baseline and 3 months after enrollment | |
Primary | Acceptability Will be Assessed by the Acceptance Rates for the Pharmacist's Recommendations | We will measure the acceptance rates for the pharmacist's recommendations as documented in the Electronic Medical Record (EMR) | 3 months after enrollment | |
Secondary | Total Medication Count | We will measure the total medication count using data obtained from the EHR. | Baseline and 3 months after enrollment | |
Secondary | Percentage of Participants With Data Elements Available to Calculate the Medication Regimen Complexity Index (pMRCI) | The feasibility of measuring this outcome will be determined as follows: Percentage of participants with data elements available vs. unavailable to calculate the pMRCI, within the existing electronic medical record systems.
This study assessed the feasibility of measuring the pMRCI and not actually determining the pMRCI. The pMRCI is a validated, widely-used tool that measures medication regimen complexity to identify patients with expected difficulty managing their regimens. Scores are derived from weighted values of regimen components (eg, dosage formulations, frequencies, and specific instructions for use). Higher scores indicate greater medication regimen complexity. |
Baseline and 3 months after enrollment | |
Secondary | Medication Regimen Complexity Index (MRCI) | The MRCI is a validated, widely-used tool that measures medication regimen complexity to identify patients with expected difficulty managing their regimens. The MRCI score is derived from weighted values of regimen components (eg, dosage formulations, frequencies, and specific instructions for use). The score has no upper limit, but higher scores indicate greater medication regimen complexity. Regimen components were combined to compute a total score and averaged. | Baseline and 3 months Baseline and 3 months after enrollment | |
Secondary | Response Rate for the Family Caregiver Medication Administration Hassles Scale (FCMAHS) | We will measure the response rate from care partners to complete the FCMAHS over the phone or electronically.
The FCMAHS is a validated caregiver-reported outcome measure that assesses burden associated with medication administration. The instrument consists of 24 items and four subscales: Information Seeking/Information Sharing (9 items), Safety Issues (5 items), Scheduling Logistics (7 items) and Polypharmacy (3 items). The total score range is 0-120 with higher scores indicating greater perceived hassle associated with managing some or all aspects of another person's medication regimen. |
Baseline and 3 months after enrollment | |
Secondary | Time to Complete the Family Caregiver Medication Administration Hassles Scale (FCMAHS) | We will measure the time it takes the care partner to complete the FCMAHS over the phone or electronically.
The FCMAHS is a validated caregiver-reported outcome measure that assesses burden associated with medication administration. The instrument consists of 24 items and four subscales: Information Seeking/Information Sharing (9 items), Safety Issues (5 items), Scheduling Logistics (7 items) and Polypharmacy (3 items). The total score range is 0-120 with higher scores indicating greater perceived hassle associated with managing some or all aspects of another person's medication regimen. |
Baseline and 3 months after enrollment | |
Secondary | Family Caregiver Medication Administration Hassles Scale (FCMAHS) | The FCMAHS is a validated caregiver-reported outcome measure that assesses burden associated with medication administration. The instrument consists of 24 items and four subscales: Information Seeking/Information Sharing (9 items), Safety Issues (5 items), Scheduling Logistics (7 items) and Polypharmacy (3 items). The total score range is 0-120 with higher scores indicating greater perceived hassle associated with managing some or all aspects of another person's medication regimen. | Baseline and 3 months after enrollment |
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