Implementation of a Pharmacist-Driven Antipsychotic Deprescribing Initiative in the PACE Setting: A Pilot Study

Study Overview
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Brief Summary
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The aim of this pilot study is to determine the feasibility of implementing an antipsychotic deprescribing initiative that is driven by pharmacists working collaboratively with the Program of All-inclusive Care for the Elderly (PACE) interdisciplinary team.

Detailed Description
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No individual antipsychotic has been approved by the U.S. Food and Drug Administration (FDA) for treating insomnia or behavioral and psychological symptoms of dementia (BPSD). Despite these medications being associated with significant harms, a considerable portion of older adults are prescribed antipsychotics for treatment of insomnia or BPSD. The aim of this study is to determine the feasibility of a pharmacist-driven antipsychotic deprescribing initiative in a community-based practice setting known as Program of All-inclusive Care for the Elderly (PACE). Our primary objective is to assess and describe the implementation process, including barriers and enablers to implementation. Our secondary objectives are to quantify and describe changes in antipsychotic prescribing following implementation; evaluate and report on antipsychotic re-initiations or changes in dosing; and evaluate and report on adverse drug withdrawal events (ADWEs) following antipsychotic deprescribing.

Official Title
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Implementation of a Pharmacist-Driven Antipsychotic Deprescribing Initiative in the Program of All-inclusive Care for the Elderly (PACE) Setting: A Pilot Study

Conditions
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Behavioral and Psychiatric Symptoms of Dementia, Insomnia

Intervention / Treatment
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* Drug: Recommendation to Deprescribe


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participant enrolled in a PACE organization during the implementation time period; PACE organization contractually receiving pharmacy services from CareKinesis during the implementation time period; and, Participant's prescriber determines that the participant could potentially benefit from deprescribing the antipsychotic. Exclusion Criteria: A diagnosis of bipolar disorder, schizophrenia, schizo-affective disorder, acute delirium, Tourette's syndrome, tic disorders, autism, intellectual disability, developmental delay, obsessive-compulsive disorder, alcoholism, cocaine abuse, Parkinson's disease psychosis, or major depressive disorder for which the antipsychotic is specifically prescribed as adjunctive treatment; Participant's prescriber determines that the participant would likely not benefit or could be harmed from deprescribing the antipsychotic; and, Participant, or healthcare decision-maker on behalf of the participant (e.g., caregiver) refuses to participate in the deprescribing initiative.

Ages Eligible for Study
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Minimum Age: 55 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Trinity Health LIFE New Jersey PACE<br>Participants enrolled in Trinity Health LIFE New Jersey PACE facility who received an antipsychotic medication for the treatment of BPSD or insomnia | Drug: Recommendation to Deprescribe<br>* Recommendation to Deprescribe<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Identify barriers and enablers to implementation of antipsychotic deprescribing initiative. | Qualitative | Three months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Implement changes in antipsychotic prescribing to patients in the PACE population. | Quantitative and Qualitative | Three months | 
| Measure the number of antipsychotic re-initiations in the PACE population. | Quantitative | Three months | 
| Measure changes in antipsychotic dosing for the PACE population. | Quantitative | Three months | 
| Identify the number of adverse drug withdrawal events (ADWEs) in the PACE population. | Quantitative and Qualitative | Three months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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sleep, antipsychotic, bpsd, deprescribing