Please select the eligibility criteria that correspond to the clinical trial below.
Title: Discontinuing Inappropriate Medication in Nursing Home Residents (the DIM NHR Study): a Cluster Randomized Controlled Trial
Brief Summary: Nursing home residents are among the frailest patient groups with a high number of co-morbidities and a high use of medicines. Inappropriate polypharmacy (i.e. often overprescribing) is one of the major problems in the nursing home population increasing the number of adverse drug reactions, falls, hospital admissions, mortality as well as having an impact on health care utilization. Multidisciplinary medication reviews have a great potential to reduce inappropriate medication use. The purpose of this study is to determine the efficacy of a multidisciplinary medication review model focussing on discontinuing inappropriate medication in a cluster randomized controlled trial in 600 nursing home residents. The primary outcome measure is the difference in proportion of residents who successfully discontinued medication between intervention and control group after four months. Secondary outcome measures will be the drug burden index, adverse drug withdrawal events related to the discontinued medication, death, referral to hospitals and quality of life.


Options:
A: Inclusion Criteria:

* Systolic blood pressure (SBP) ≥140 mmHg in those \<70 years old or ≥160 mmHg in those ≥70 years old or diastolic blood pressure (DBP) ≥90 mmHg in a sitting position on two consecutive measurements at clinic
* At least one of the following risk factors:

  * SBP ≥180 mmHg or DBP ≥110 mmHg on two consecutive visits;
  * Type 2 diabetes (fasting blood glucose ≥126 mg/dl, causal blood glucose ≥200 mg/dl, HbA1c ≥6.5%, 2 hours blood glucose on 75 g oral glucose tolerance test \[OGTT\] ≥200 mg/dl, or current treatment with hypoglycemic agent);
  * History of cerebral hemorrhage, cerebral infarction, or transient ischemic attack until 6 months prior to the screening;
  * Thickness of the posterior wall of left ventricle or thickness of the wall of interventricular septum ≥12 mm on echocardiography or Sv1＋Rv5 ≥35 mm on electrocardiography, angina pectoris, and a past history (≥6 months before giving informed consent) of myocardial infarction;
  * Proteinuria ≥＋1 or renal impairment (serum creatinine ≥1.3 mg/dl) within 3 months at the time of giving informed consent;
  * Arteriosclerotic peripheral arterial obstruction (Fontaine class ≥2); \*Clinical diagnosis of Alzheimer's disease.

Exclusion Criteria:

* SBP ≥200 mmHg or DBP ≥120 mmHg in a sitting position
* Type I diabetes mellitus
* History of myocardial infarction or cerebrovascular accidents within 6 months prior to the screening
* Percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) done within 6 months of screening or scheduled
* Current treatment for congestive cardiac failure (New York Heart Association \[NYHA\] functional class II or severer) or ejection fraction \<40%
* Coronary artery disease requiring αβ blocker or calcium channel blocker
* Atrial fibrillation or atrial flutter
* Renal dysfunction (serum creatinine ≥3 mg/dl)
* Hepatic dysfunction (AST and/or ALT ≥100 IU/l)
* A history of malignant tumor within 5 years of enrollment or suspected
* Contraindication for candesartan cilexetil or amlodipine besilate
* Pregnancy, possible pregnancy, or plan to conceive a child within 5 years of enrollment
* Not suited to the clinical trial as judged by a collaborating physician
* Inability to give informed consent
B: Inclusion Criteria:

* more than 3 drugs over at least 3 months prior to recruitment
* german or french language (written and spoken)
* medicines use in self management

Exclusion Criteria:

* provision of Polymedication Check in the past
* living in a nursing home
* use of prefilled pill organiser or individually blistered medication
C: Nursing Home Wards:

Inclusion criteria:

* Long stay ward
* Capability and commitment to perform a multidisciplinary multistep medication review.

Exclusion criteria:

* Short stay, revalidation or observation wards
* Specialized ward where patients with an atypical etiology are cared for.
* Elderly care physicians who have recently received or who are to receive recertification at short notice with regard to systematic medication review methodology.
* Participation in other studies aimed at improving the quality of drug prescription (in the past 12 months).

Nursing Home Residents:

Inclusion criteria:

* A life expectancy of \>4 weeks as judged by the treating elderly care physician.
* IC provided by patients themselves or provided by a legal representative for incapacitated patients.

Exclusion criteria:

* Refusal of treatment with medicines.
* Having received a multidisciplinary systematic medication review in the past 6 months.
* Being terminally ill and having a life expectancy ≤ 4 weeks as judged by the treating elderly care physician.
* Other reasons at the discretion of the elderly care physician / nursing staff
D: Inclusion Criteria:

* Patients 65-74 years of age with multimorbidity (3 or more chronic diseases) and polypharmacy (5 or more drugs taken for at least three months).
* Informed consent.

Exclusion Criteria:

* Institutionalized patient at nursing homes or similar
* Life expectancy \< 12 months

Answer: C