Nursing Home Team-Care Deprescribing Study

Study Overview
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Brief Summary
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This is a multi-centre study in Singapore nursing homes, investigating the factors that affecting deprescribing, and if a team-care based deprescribing standard practice gives superior health and pharmacoeconomic outcomes over current medication review practice.

Official Title
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Nursing Home Team-Care Deprescribing Study

Conditions
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Fall in Nursing Home, Medication Therapy Management

Intervention / Treatment
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* Other: Team-care deprescribing with deprescribing guide


Participation Criteria
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Eligibility Criteria
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For interview questionnaire: Inclusion criteria are: Accepted informed consent, The healthcare professional is practicing in the involved nursing homes. Exclusion criteria are: 1) Decline/unable to provide consent. For team-care deprescribing study: Inclusion criteria are: Accepted informed consent (unless cognitive-impaired, with no or un-contactable next-of-kin), Adult aged 65 years and above, Currently on five or more medications. Exclusion criteria are: Below the age of 65 years of age, Life expectancy of less than 6 months or respite care.

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: Health Services Research
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: naive Deprescribing arm<br>Team-based deprescribing practice, Deprescribing Guide | Other: Team-care deprescribing with deprescribing guide<br>* Beers criteria 2015, STOPP criteria 2014, drug interaction<br>|
| No Intervention: naive Wait-list Control arm<br> | |
| Experimental: non-naive Deprescribing arm<br>Team-based deprescribing practice, Deprescribing Guide | Other: Team-care deprescribing with deprescribing guide<br>* Beers criteria 2015, STOPP criteria 2014, drug interaction<br>|
| No Intervention: non-naive Wait-list Control arm<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in Fall Risk Assessment Tool (FRAT) score |  | Change from baseline in FRAT score at 3 months | 
| Change from baseline in Fall Risk Assessment Tool (FRAT) score |  | Change from baseline in FRAT score at 6 months | 
| Change from baseline in Fall Risk Assessment Tool (FRAT) score |  | Change from baseline in FRAT score at 12 months | 
| Change from baseline in fall rate |  | Change from baseline in fall rate at 3 months | 
| Change from baseline in fall rate |  | Change from baseline in fall rate at 6 months | 
| Change from baseline in fall rate |  | Change from baseline in fall rate at 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Factors affecting deprescribing | Interview questionnaire | 0 month | 
| Change from baseline in mean number of medications per subject |  | Change from baseline in mean number of medications per subject at 3 months | 
| Change from baseline in mean number of medications per subject |  | Change from baseline in mean number of medications per subject at 6 months | 
| Change from baseline in mean number of medications per subject |  | Change from baseline in mean number of medications per subject at 12 months | 
| Change from baseline in mean medication cost per subject |  | Change from baseline in mean medication cost at 3 months | 
| Change from baseline in mean medication cost per subject |  | Change from baseline in mean medication cost at 6 months | 
| Change from baseline in mean medication cost per subject |  | Change from baseline in mean medication cost at 12 months | 
| Change from baseline in deprescribing intervention acceptance rate |  | Change from baseline in deprescribing intervention acceptance rate at 3 months | 
| Change from baseline in deprescribing intervention acceptance rate |  | Change from baseline in deprescribing intervention acceptance rate at 6 months | 
| Change from baseline in deprescribing intervention acceptance rate |  | Change from baseline in deprescribing intervention acceptance rate at 12 months | 
| Change from baseline in percentage of drug-related problems (DRPs) | Medication review form (Hepler/Strand DRP classification system) | Change from baseline in percentage of DRPs at 3 months | 
| Change from baseline in percentage of drug-related problems (DRPs) | Medication review form (Hepler/Strand DRP classification system) | Change from baseline in percentage of DRPs at 6 months | 
| Change from baseline in percentage of drug-related problems (DRPs) | Medication review form (Hepler/Strand DRP classification system) | Change from baseline in percentage of DRPs at 12 months |