Deprescribing in a Long Term Care Facility

NCT03091153 | Completed

• 1 other identifier: HREB - 2016.312
• Study Type: interventional
• Target: 67
• Locations: 1 country
• Sites: 1

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.

Conditions

Polypharmacy

Outcome Measures

Primary Outcomes (1)

• 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 Outcomes (10)

• All cause mortality rate

  3 and 6 months after receiving the intervention

• Instance of falls in the last 30 days

  3 and 6 months after receiving the intervention

• Frequency of emergency room visits, unplanned hospital admission and/or unplanned GP visits

  3 and 6 months after receiving the intervention

• Cognitive function score

  3 and 6 months after receiving the intervention

• Bowel function

  baseline, 3 and 6 months after receiving the intervention

Study Arms (2)

Control

NO INTERVENTION

Standard care. Annual medication review

Intervention

EXPERIMENTAL

In depth medication review with a focus on deprescribing

Other: Medication Review

Interventions

Medication Review OTHER

In depth medication review with a focus on deprescribing

Intervention

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

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

You may not qualify if:

• 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

Sponsors & Collaborators

• Memorial University of Newfoundland: lead
• Eastern Health: collaborator

Study Sites (1)

St Patrick's Mercy Home

St. John's, Newfoundland and Labrador, Canada

Location

MeSH Terms

Interventions

Medication Review

Intervention Hierarchy (Ancestors)

Medication Systems; Organization and Administration; Health Services Administration; Patient Care Management

Study Officials

• Deborah Kelly, PharmD

  Memorial University of Newfoundland

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: March 21, 2017
• First Posted: March 27, 2017
• Study Start: March 30, 2017
• Primary Completion: December 31, 2018
• Study Completion: June 1, 2019
• Last Updated: July 22, 2019

Record last verified: 2019-07

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)