Opportunities and Limits to Deprescribing in Nursing Homes:Quality Circle Deprescribing Module

Study Overview
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Brief Summary
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Older people residing in nursing homes (NH) are frequently polymedicated and often prescribed potentially inappropriate medications. Deprescribing has been proposed as a way to reduce the number of drugs they receive and their exposure to harmful treatments. The objectives of this study are 1) To evaluate the effect of a deprescribing-specific interdisciplinary quality circle module on the use of potentially inappropriate medication in nursing-home residents. 2) To determine the effective strategies to reach and implement deprescribing consensus resulting of said quality circle module.

Official Title
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Opportunities and Limits to Deprescribing in Nursing Homes:Quality Circle Deprescribing Module

Conditions
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Polypharmacy, Inappropriate Prescribing

Intervention / Treatment
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* Other: Quality Circle Deprescribing Module


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Nursing homes taking part in the study must have a geriatric of psycho-geriatric mission; been part of their cantonal pharmaceutical assistance program for at least a year. Exclusion Criteria: None
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Nursing Homes allocated to the Intervention arm will enact the Quality Circle Deprescribing Module and create a local deprescribing consensus and implementation strategy. | Other: Quality Circle Deprescribing Module<br>* The Quality Circle Deprescribing Module consist of a discussion bringing together nurses, physicians and responsible pharmacist to create a local deprescribing consensus for frequently used drug classes, as well as implementation strategies for the consensus..<br>|
| No Intervention: Control<br>Nursing Homes allocated to the Control arm will not enact the intervention. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Potentially Inappropriate Galenic Units | The primary outcome is the percentage, at follow-up, of potentially inappropriate galenic units at follow-up, relative to the total number of galenic units used in the nursing home. | 12 months | 
| Number of Potentially Inappropriate Defined Daily Doses (DDDs) Per Average Resident and Per Day | Sum of Defined Daily Doses identified as potentially inappropriate (PIM, see protocol for assessement method), divided by the total number of days spent in the NH | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Potentially Inappropriate DDD to Avoid | Sum of Defined Daily Doses identified as to avoid (see protocol for assessement method), divided by the total number of days spent in the NH. | 12 months | 
| Number of Potentially Inappropriate DDD to Reevaluate | Sum of Defined Daily Doses identified as to reevaluate (see protocol for assessement method), divided by the total number of days spent in the NH. | 12 months | 
| Number of Hospital Days | The number of days spent in the hospital by average resident | 12 months | 
| Mortality Rate | Number of residents of the nursing home having died during the considered year, divided by the total number of residents having stayed in the nursing home. | 12 months | 
| Number of Falls Per Average Resident and Per Year | Number of falls per average resident and per year | 12 months | 
| Percentage of Residents With at Least One Day of Physical Restraints Use | Number of residents of the nursing home with at least one day of physical restraints use during the considered year, divided by the total number of residents having stayed in the nursing home. | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Deprescribing, Inappropriate Medication, Nursing Homes