Clinical trial NCT03091153: Deprescribing in a Long Term Care Facility
Official title: Impact of a Deprescribing Intervention on Nursing Home Residents: a Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Polypharmacy
Lead sponsor: Memorial University of Newfoundland
Sponsor class: OTHER
Collaborators: name: Eastern Health
First posted: 2017-03-27
Enrollment: 67
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: 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.


Eligibility criteria: Inclusion Criteria (all of the following):

1. Over 65 years of age
2. Reside in St. Patrick's Mercy Home (2nd or 3rd floor units)

Exclusion Criteria (any of the following):

1. Do not take any regularly scheduled medications
2. Are receiving palliative care
3. Resident's physician or nursing team do not support participation
4. Resident or their substitute decision maker decline participation

Primary outcomes:
measure: Change in number of medications taken daily by residents
timeFrame: 3 and 6 months after receiving intervention
Secondary outcomes:
measure: All cause mortality rate
timeFrame: 3 and 6 months after receiving the intervention
measure: Instance of falls in the last 30 days
timeFrame: 3 and 6 months after receiving the intervention
measure: Frequency of emergency room visits, unplanned hospital admission and/or unplanned GP visits
timeFrame: 3 and 6 months after receiving the intervention
measure: Cognitive function score
timeFrame: 3 and 6 months after receiving the intervention
measure: Bowel function
timeFrame: baseline, 3 and 6 months after receiving the intervention
measure: Independence in activities of daily living
timeFrame: 3 and 6 months after receiving the intervention
measure: Changes in general health
timeFrame: 3 and 6 months after receiving the intervention
measure: Social engagement
timeFrame: 3 and 6 months after receiving the intervention
measure: Aggressive behaviour
timeFrame: 3 and 6 months after receiving the intervention
measure: Frequency of pain
timeFrame: 3 and 6 months after receiving the intervention
Other outcomes:
Locations:
city: St. John's
country: Canada
facility: St Patrick's Mercy Home
state: Newfoundland and Labrador
Study officials:
affiliation: Memorial University of Newfoundland
name: Deborah Kelly, PharmD
role: PRINCIPAL_INVESTIGATOR
References: