Appropriate Prescribing for Older Adults With Multimorbidity (Pro-M)
Condition: Potentially Inappropriate Medications; Multimorbidity; Polypharmacy
Study type: Interventional

Summary: 
      This is a two-site feasibility study to test implementation of an intervention that aims to
      reduce inappropriate prescribing for older adults with multimorbidity in geriatric medicine
      specialist clinics at public hospitals in Singapore. The specific aims are:

        1. To assess the implementation outcomes: Appropriateness, Penetration/Reach,
           Acceptability, Feasibility, Sustainability (primary)

        2. To collect data on recruitment and pre-post data on prevalence of potentially
           inappropriate prescribing (PIP) for the purpose of determining sample size for a scale
           up next phase study (secondary).

        3. To conduct cost analysis of the intervention (secondary).
    

Detailed description: 
      The Appropriate prescribing for older adults with multi-morbidity (Pro-M) study aims to
      assess the feasibility of implementing routine medication review using prescribing criteria
      for older adults with multi-morbidity at the Geriatric Medicine outpatient clinics at 2
      public hospitals in Singapore. The study will consist of a recruitment and implementation
      period and an evaluation period at the end.

      Flow of the intervention (6 months):

        1. Eligible patients with multimorbidity and are taking at least 5 medications daily will
           be identified and invited by the doctor to undergo medication review (MR).

        2. Patients will undergo medication reviews with a pharmacist, involving the use of
           specific prescribing criteria and tools (e.g. STOPP/START, Beers Criteria), as
           determined by the sites.

        3. Medication review findings will be documented in the electronic medical records and
           shared with the doctor, who will review the findings and make necessary changes to
           patients' prescriptions during consultations with the patients.

        4. The Doctors will document the review outcome and prescribing decisions in the electronic
           medical records and communicate the changes (if any) to other relevant prescribers.

        5. Patients will be invited to do a short survey on their experiences of the intervention
           at the end to assess implementation outcomes.

      The intervention will be compared to 'usual care', where medication review is only done in an
      ad-hoc and informal basis. Patients' last consultation prior to the intervention period would
      be used as the point to measure 'usual care'.

      Evaluation(3 months):

      Doctors and pharmacists who implemented the study (delivery or support) will be invited to a
      survey and selected in-depth interviews to assess implementation outcomes.
    

Intervention name(s): Medication review
Intervention type(s): Other
Intervention description(s): This is a feasibility study of implementing a pharmacist-led medication review using prescribing tools (e.g. STOPP/START, Beers Criteria)
Intervention model: Single Group Assignment
Intervention model description: In order to investigate if implementing routine pharmacist-led medication reviews in the outpatient clinics of public hospitals for older adults with multi-morbidity, we are conducting a single-arm study at 2 sites to understand how the implementation strategies could be best carried out to facilitate the aim to reduce inappropriate prescribing. Pre- and post-medication review data on potentially inappropriate medications and other issues flagged will also be collected for a future scale up study. Each site is expected to recruit 30 patients.
An evaluation will also be conducted with the doctors and pharmacists delivering and implementing the study.
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Inappropriate prescribing; Feasibility study