Deprescribing in a Long Term Care Facility

Study Overview
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Brief Summary
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This study will develop, implement and evaluate a deprescribing initiative at a Canadian Long Term Care (LTC) Facility. Residents currently undergo an annual medication review as part of the clinical pharmacy services provided in the LTC facility. For this study, eligible residents will be randomized to receive either a deprescribing focused medication review or usual care. The deprescribing focused medication therapy assessments will be done on half of the 143 residents residing on the second and third floors of the facility. The other half of residents will serve as the control group and continue to receive their annual medication review and regular care from the attending physicians and nurses. The deprescribing intervention will be delivered by final year pharmacy students completing their practice experiences, under the supervision of clinical pharmacists at the LTC facility and clinical pharmacists from Memorial University's Medication Therapy Services (MTS) Clinic. Currently the clinic has a well developed procedure for providing in depth medication therapy reviews for residents of the community, upon referral by their primary care physician. Students will adapt this model of medication review to have a stronger deprescribing focus and be applicable to elderly residents of a LTC facility. The intervention will consist of an in depth medication therapy review with a focus on identifying any medications that may no longer be required or are deemed to be inappropriate or potentially unsafe in the elderly based on currently guidelines/criteria. The students will work closely with members of the resident's care team on a daily basis, as well as the resident and their family, to develop and implement a deprescribing plan.

Official Title
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Impact of a Deprescribing Intervention on Nursing Home Residents: a Randomized Controlled Trial

Conditions
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Polypharmacy

Intervention / Treatment
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* Other: Medication Review


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria (all of the following): Over 65 years of age Reside in St. Patrick's Mercy Home (2nd or 3rd floor units) Exclusion Criteria (any of the following): Do not take any regularly scheduled medications Are receiving palliative care Resident's physician or nursing team do not support participation Resident or their substitute decision maker decline participation

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
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>Standard care. Annual medication review | |
| Experimental: Intervention<br>In depth medication review with a focus on deprescribing | Other: Medication Review<br>* In depth medication review with a focus on deprescribing<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in number of medications taken daily by residents | Measured using facility medication logs and patient health records | 3 and 6 months after receiving intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| All cause mortality rate | Measured using patient health records | 3 and 6 months after receiving the intervention | 
| Instance of falls in the last 30 days | Measured using facility fall report logs | 3 and 6 months after receiving the intervention | 
| Frequency of emergency room visits, unplanned hospital admission and/or unplanned GP visits | Measured using patient health records | 3 and 6 months after receiving the intervention | 
| Cognitive function score | Measured using Cognitive Performance Scale (CPS) obtained from Resident Assessment Instrument (RAI) MDS 2.0 | 3 and 6 months after receiving the intervention | 
| Bowel function | Measured using bowel chart data for the 14 days prior to the assessment date | baseline, 3 and 6 months after receiving the intervention | 
| Independence in activities of daily living | Measured using the Activities of Daily Living Scale (ADL) obtained from RAI MDS 2.0 | 3 and 6 months after receiving the intervention | 
| Changes in general health | Measured using the Changes in Health, End-Stage Disease and Signs and Symptoms (CHESS) Score obtained from RAI MDS 2.0 | 3 and 6 months after receiving the intervention | 
| Social engagement | Measured using Index of Social Engagement (ISE) Score obtained from RAI MDS 2.0 | 3 and 6 months after receiving the intervention | 
| Aggressive behaviour | Measured using the Aggressive Behaviour Scale (ABS) obtained from RAI MDS 2.0 | 3 and 6 months after receiving the intervention | 
| Frequency of pain | Measured using the Pain Scale obtained from RAI MDS 2.0 | 3 and 6 months after receiving the intervention |