Efficacy and Feasibility of De-prescribing Rounds in a Singapore Rehabilitative Hospital- a Pilot Randomized Controlled Trial

NCT03713112 | Unknown DMC

• 1 other identifier: CIRB Ref 2018/2721
• Study Type: interventional
• Target: 260
• Locations: 1 country
• Sites: 1

Brief Summary

This open-labelled randomized control trial will be conducted in a Singapore Rehabilitation Hospital to investigate the efficacy, cost-reduction, safety and feasibility of a weekly deprescribing multi-disciplinary inpatient deprescribing round up to 28 days post discharge.

Conditions

Deprescribing; Multi-disciplinary; Rounds

Keywords

deprescribe; multi-disciplinary; open label; rounds; randomised controlled trial

Outcome Measures

Primary Outcomes (1)

• Change in total daily dose of medication upon discharge from the hospital

  Change in total daily dose of medication upon discharge from the hospital

  During the patient's inpatient stay (this will be measured on the day of discharge, usually ranging between 21 to 49 days upon inpatient admission)

Secondary Outcomes (4)

• Cost savings measured in Singapore dollars

  These outcomes will be measured on days 14, 28 of inpatient admission, the day of inpatient discharge (*this is usually between 21 to 49 days after admission) and day 28 post discharge. Overall timeframe ranges between 49 to 77days after admission.

• Number of participants with side effects from deprescribing

  These outcomes will be measured on days 14, 28 of inpatient admission, the day of inpatient discharge (*this is usually between 21 to 49 days after admission) and day 28 post discharge. Overall timeframe ranges between 49 to 77days after admission.

• feasibility of intervention in terms of time taken, measured in minutes.

  During the patient's inpatient stay (this will be measured on the day of discharge, usually ranging between 21 to 49 days upon inpatient admission)

• feasibility of intervention in terms of ease at which the rounds are conducted (descriptive)

  During the patient's inpatient stay (this will be measured on the day of discharge, usually ranging between 21 to 49 days upon inpatient admission)

Study Arms (2)

Weekly MDT deprescribing rounds

ACTIVE COMPARATOR

Weekly MDT deprescribing rounds for certain drugs will be performed on top of usual care.

Other: Weekly MDT deprescribing rounds for certain drugs

Control (Usual Care)

NO INTERVENTION

Usual Care includes the following: * De-prescribing at the discretion of the ward doctors * Initial medication reconciliation by pharmacist on admission * Ward rounds to be conducted 3 weekdays per week for rehabilitative patients and daily on weekdays for sub-acute patients.

Interventions

Weekly MDT deprescribing rounds for certain drugs OTHER

* Weekly deprescribing round (from randomization to day of discharge) * Conducted by a multidisciplinary team (non-ward doctors, pharmacist, ward nurse) * Using the 5 steps of de-prescribing * De-prescribing targets: 1. Beer's list of potentially inappropriate medications (American Geriatric Society 2015 version) 2. Supplements of questionable benefits (glucosamine, chondroitin, vitamin B complex and multivitamins) 3. Symptomatic medications (laxatives, gastro-protectives, painkillers, anti-emetics and steroid creams) (Standardized verbal script to initiate de-prescribing by the team) * On top of usual care

Weekly MDT deprescribing rounds

Eligibility Criteria

• Age: 65 Years - 120 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Older Adult (65+)

You may qualify if:

• Greater or equals to 65 years old
• Newly admitted to rehabilitation or sub-acute disciplines
• Possess 1 or more of the targeted medications

You may not qualify if:

• Abbreviated mental test less than 7
• No mental capacity

Sponsors & Collaborators

• Bright Vision Hospital: lead

Study Sites (1)

Bright Vision Hospital

Singapore, 547530, Singapore

Location

Related Publications (6)

• Roberts MS, Stokes JA, King MA, Lynne TA, Purdie DM, Glasziou PP, Wilson DA, McCarthy ST, Brooks GE, de Looze FJ, Del Mar CB. Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. Br J Clin Pharmacol. 2001 Mar;51(3):257-65. doi: 10.1046/j.1365-2125.2001.00347.x.

  PMID: 11298072 RESULT

• Kutner JS, Blatchford PJ, Taylor DH Jr, Ritchie CS, Bull JH, Fairclough DL, Hanson LC, LeBlanc TW, Samsa GP, Wolf S, Aziz NM, Currow DC, Ferrell B, Wagner-Johnston N, Zafar SY, Cleary JF, Dev S, Goode PS, Kamal AH, Kassner C, Kvale EA, McCallum JG, Ogunseitan AB, Pantilat SZ, Portenoy RK, Prince-Paul M, Sloan JA, Swetz KM, Von Gunten CF, Abernethy AP. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015 May;175(5):691-700. doi: 10.1001/jamainternmed.2015.0289.

  PMID: 25798575 RESULT

• Williams ME, Pulliam CC, Hunter R, Johnson TM, Owens JE, Kincaid J, Porter C, Koch G. The short-term effect of interdisciplinary medication review on function and cost in ambulatory elderly people. J Am Geriatr Soc. 2004 Jan;52(1):93-8. doi: 10.1111/j.1532-5415.2004.52016.x.

  PMID: 14687321 RESULT

• Reeve E, Andrews JM, Wiese MD, Hendrix I, Roberts MS, Shakib S. Feasibility of a patient-centered deprescribing process to reduce inappropriate use of proton pump inhibitors. Ann Pharmacother. 2015 Jan;49(1):29-38. doi: 10.1177/1060028014558290. Epub 2014 Nov 10.

  PMID: 25385826 RESULT

• Frank C, Weir E. Deprescribing for older patients. CMAJ. 2014 Dec 9;186(18):1369-76. doi: 10.1503/cmaj.131873. Epub 2014 Sep 2. No abstract available.

  PMID: 25183716 RESULT

• Wong APY, Ting TW, Charissa EJM, Boon TW, Heng KY, Leng LL. Feasibility & Efficacy of Deprescribing rounds in a Singapore rehabilitative hospital- a randomised controlled trial. BMC Geriatr. 2021 Oct 21;21(1):584. doi: 10.1186/s12877-021-02507-0.

  PMID: 34674645 DERIVED

Study Officials

• Wong Peng Yong, Andrew, MBBS

  Bright Vision Hospital; Singhealth Community Hospitals

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: The 2 arms of rehabilitative and/or subacute care patients consist of the intervention arm (receiving weekly multidisciplinary rounds up to the point of discharge, using 5 steps of deprescribing at the bedside, targeted to deprescribe selected medications \[Beers' List of inappropriate Medications 2015; selected supplements and selected symptomatic medications\]) and control arm (receving usual care)

Study Record Dates

• First Submitted: October 12, 2018
• First Posted: October 19, 2018
• Study Start: November 28, 2018
• Primary Completion: July 31, 2019
• Study Completion: June 30, 2020
• Last Updated: May 20, 2020

Record last verified: 2020-05

Data Sharing

• IPD Sharing: Will not share

Locations

SG (1)