Deprescribing for Older Adults After Hospital Discharge in Home Health Care

Study Overview
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Brief Summary
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The purpose of this study is to examine the feasibility of providing a medication optimization program to improve patient health outcomes during the transition from hospital to home. This is because the period after hospital discharge is critical to long-term recovery, overall quality of life, and prevention of future hospitalizations.

Official Title
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Deprescribing for Older Adults After Hospital Discharge in Home Health Care - A Pilot Feasibility Study of the HomeMed Deprescribing Intervention

Conditions
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Polypharmacy

Intervention / Treatment
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* Behavioral: HomeMed


Participation Criteria
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Eligibility Criteria
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Patient Inclusion Criteria: 65 years of age and older currently hospitalized or having been hospitalized in the previous 2 weeks having a discharge disposition of home with a referral to receive HHC services from URMHC, or currently receiving HHC services from URMHC taking more than 10 regular medications daily having a primary care provider who is in the URMC system Ability to self-consent English-speaking Patient Exclusion Criteria: end-of-life prognosis in the following 6 months currently receiving hospice care, end-of-life care, or palliative care conditions that impact the receipt of the intervention, such as severe cognitive impairment that interferes with the subject's ability to communicate with interventionists; substantial difficulties in hearing, vision, and verbal expression that disable the participant from communicating effectively while receiving the HomeMed intervention

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: All Participants<br> | Behavioral: HomeMed<br>* The HomeMed intervention is a multidisciplinary deprescribing intervention including home visits and team-based telehealth communication (optional). The components included in the HomeMed intervention include home medication review, medication education and provision of tools to assist the patients with medication administration, assessment of deprescribing targets by a trained geriatric clinical pharmacist, communication with the patient's treating primary care provider about deprescribing recommendation, deprescribing implementation (optional), and deprescribing monitoring (optional). Depending on the patient's treating primary care provider's decision on deprescribing and monitoring, the number of home visits ranges from a minimum of three to more with the entire duration of the intervention ranging from approximately 1 to 3 months.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mean time spent on intervention |  | 3 months | 
| number of participants who complete a post intervention survey about feasibility |  | 3 months | 
| Percentage of participants undergoing deprescribing |  | 3 months | 
| Percentage of intervention adherence indicators checked |  | 3 months | 
| Percentage of patients who improve in ability to do things that are important before and after intervention |  | 3 months | 
| Total number of medications used per participant |  | 3 months | 
| Percentage of patients who report a reduction in medication burden | Medication burden will be reported by phone or survey. | 3 months | 
| Percentage of participants who report a reduction in medication side effect | Side effects will be collected by phone. | 3 months |