Spread and Scale of a Polypharmacy App
1 other identifier
interventional
1,000
1 country
5
Brief Summary
Medication overload is an epidemic causing widespread harm, particularly to older Canadians. While most prescriptions are intended to help people live longer and healthier lives, taking multiple medications can increase frailty, and lead to dangerous side effects.This is a mixed-methods study to determine the impact of MedReviewRx on prescribing in New Brunswick Nursing Homes (NBNHs). MedReviewRx is an application which allows MedSafer to analyze a person's medications and medical conditions and produce a report with suggestions for how to simplify medications and make them safer. MedSafer reports will be used to assist physicians and pharmacists identify potentially inappropriate medications (PIMs) and conduct medication reviews in NBNHs. The prevalence of PIMs in NBNHs before MedReviewRx will be measured and the change in PIM use after implementation will be calculated. User experience with MedSafer reports and MedReviewRx will be explored. Patient and Family attitudes towards deprescribing will also be studied. Investigators hypothesize that implementing MedReviewRx in New Brunswick Nursing Homes (NBNHs) will promote deprescribing which will lead to a decrease in the number of PIMs and a decrease in medication costs for older adults living in NBNHs.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Aug 2021
5 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
Click on a node to explore related trials.
Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
February 9, 2021
CompletedFirst Posted
Study publicly available on registry
February 21, 2021
CompletedStudy Start
First participant enrolled
August 1, 2021
CompletedPrimary Completion
Last participant's last visit for primary outcome
July 31, 2022
CompletedStudy Completion
Last participant's last visit for all outcomes
October 31, 2022
CompletedJune 16, 2021
February 1, 2021
12 months
February 9, 2021
June 11, 2021
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Impact of MedReviewRx on the prevalence of potentially inappropriate medications (PIMs) in New Brunswick nursing homes (NBNHs).
The impact on PIMs will be determined by the proportion of nursing home residents who have one or more PIMs reduced or stopped after the treating physician receives a MedSafer report
Baseline to 3 months
Secondary Outcomes (39)
Proportion of patients with one or more PIM reduced or stopped following each cycle.
90-days following the first intervention cycle (9-months)
Proportion of patients with one or more PIM reduced or stopped following each cycle.
90-days following the second intervention cycle (6-months)
Proportion of patients with one or more PIM reduced or stopped following each cycle.
90-days following the third intervention cycle (3-months)
Number of deaths
90-days following the first intervention cycle (9-months)
Number of deaths
90-days following the second intervention cycle (6-months)
- +34 more secondary outcomes
Other Outcomes (4)
Cost savings
1 year
Patient and family attitudes about deprescribing
90-days following the first intervention cycle (9-months)
Patient and family attitudes about deprescribing
90-days following the second intervention cycle (6-months)
- +1 more other outcomes
Study Arms (2)
MedReviewRx
EXPERIMENTALDuring the intervention phase, MedReviewRx will be made available to nursing homes with the understanding that it will be used to facilitate medication reviews and prescription check-ups. MedReviewRx provides clinicians with access to individualized and prioritized deprescribing information from MedSafer which: a) identifies potentially inappropriate medications (PIMs), b) explains why the medication is potentially inappropriate and c) provides instructions on how to safely stop/taper the medication.
No MedReviewRx
NO INTERVENTIONDuring the control phase, MedReviewRx will not be accessible to health care professionals at the nursing homes. This serves to obtain baseline deprescribing levels for each nursing home.
Interventions
During the intervention phase, MedReviewRx will be made available to nursing homes with the understanding that it will be used to facilitate medication reviews and prescription check-ups. MedReviewRx provides clinicians with access to individualized and prioritized deprescribing information from MedSafer which: a) identifies potentially inappropriate medications (PIMs), b) explains why the medication is potentially inappropriate and c) provides instructions on how to safely stop/taper the medication.
Eligibility Criteria
You may qualify if:
- All residents of the participating New Brunswick nursing homes (NBNHs)
- All residents who are 65 years of age or older
- All residents who are taking a potentially inappropriate medication (as identified by MedSafer)
You may not qualify if:
- If both the patient and proxy are unable to complete the survey, the patient will be excluded from the survey component of the study.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (5)
York Care Centre
Fredericton, New Brunswick, E3A 1A3, Canada
Faubourg du Mascaret
Moncton, New Brunswick, E1E 3R8, Canada
Spencer Nursing Home
Moncton, New Brunswick, E1E 4N3, Canada
Shannex Embassy Hall
Quispamsis, New Brunswick, E2E 0M4, Canada
Loch Lomond Villa
Saint John, New Brunswick, E2J 3S3, Canada
Related Publications (23)
AlRasheed MM, Alhawassi TM, Alanazi A, Aloudah N, Khurshid F, Alsultan M. Knowledge and willingness of physicians about deprescribing among older patients: a qualitative study. Clin Interv Aging. 2018 Aug 6;13:1401-1408. doi: 10.2147/CIA.S165588. eCollection 2018.
PMID: 30122912BACKGROUNDCaputo A. Trends of psychology-related research on euthanasia: a qualitative software-based thematic analysis of journal abstracts. Psychol Health Med. 2015;20(7):858-69. doi: 10.1080/13548506.2014.993405. Epub 2014 Dec 20.
PMID: 25530297BACKGROUNDBrath H, Mehta N, Savage RD, Gill SS, Wu W, Bronskill SE, Zhu L, Gurwitz JH, Rochon PA. What Is Known About Preventing, Detecting, and Reversing Prescribing Cascades: A Scoping Review. J Am Geriatr Soc. 2018 Nov;66(11):2079-2085. doi: 10.1111/jgs.15543. Epub 2018 Oct 18.
PMID: 30335185BACKGROUNDConklin J, Farrell B, Suleman S. Implementing deprescribing guidelines into frontline practice: Barriers and facilitators. Res Social Adm Pharm. 2019 Jun;15(6):796-800. doi: 10.1016/j.sapharm.2018.08.012. Epub 2018 Sep 18.
PMID: 30241874BACKGROUNDDills H, Shah K, Messinger-Rapport B, Bradford K, Syed Q. Deprescribing Medications for Chronic Diseases Management in Primary Care Settings: A Systematic Review of Randomized Controlled Trials. J Am Med Dir Assoc. 2018 Nov;19(11):923-935.e2. doi: 10.1016/j.jamda.2018.06.021. Epub 2018 Aug 11.
PMID: 30108032BACKGROUNDDjatche L, Lee S, Singer D, Hegarty SE, Lombardi M, Maio V. How confident are physicians in deprescribing for the elderly and what barriers prevent deprescribing? J Clin Pharm Ther. 2018 Aug;43(4):550-555. doi: 10.1111/jcpt.12688. Epub 2018 Apr 22.
PMID: 29682764BACKGROUNDMcDonald EG, Wu PE, Rashidi B, Forster AJ, Huang A, Pilote L, Papillon-Ferland L, Bonnici A, Tamblyn R, Whitty R, Porter S, Battu K, Downar J, Lee TC. The MedSafer Study: A Controlled Trial of an Electronic Decision Support Tool for Deprescribing in Acute Care. J Am Geriatr Soc. 2019 Sep;67(9):1843-1850. doi: 10.1111/jgs.16040. Epub 2019 Jun 27.
PMID: 31250427BACKGROUNDSirois C, Ouellet N, Reeve E. Community-dwelling older people's attitudes towards deprescribing in Canada. Res Social Adm Pharm. 2017 Jul-Aug;13(4):864-870. doi: 10.1016/j.sapharm.2016.08.006. Epub 2016 Aug 31.
PMID: 27663392BACKGROUNDThillainadesan J, Gnjidic D, Green S, Hilmer SN. Impact of Deprescribing Interventions in Older Hospitalised Patients on Prescribing and Clinical Outcomes: A Systematic Review of Randomised Trials. Drugs Aging. 2018 Apr;35(4):303-319. doi: 10.1007/s40266-018-0536-4.
PMID: 29541966BACKGROUNDvan der Sluijs R, Fiddelers AAA, Waalwijk JF, Reitsma JB, Dirx MJ, den Hartog D, Evers SMAA, Goslings JC, Hoogeveen WM, Lansink KW, Leenen LPH, van Heijl M, Poeze M. The impact of the Trauma Triage App on pre-hospital trauma triage: design and protocol of the stepped-wedge, cluster-randomized TESLA trial. Diagn Progn Res. 2020 Jun 18;4:10. doi: 10.1186/s41512-020-00076-1. eCollection 2020.
PMID: 32566758BACKGROUNDBarker D, D'Este C, Campbell MJ, McElduff P. Minimum number of clusters and comparison of analysis methods for cross sectional stepped wedge cluster randomised trials with binary outcomes: A simulation study. Trials. 2017 Mar 9;18(1):119. doi: 10.1186/s13063-017-1862-2.
PMID: 28279222BACKGROUNDWoertman W, de Hoop E, Moerbeek M, Zuidema SU, Gerritsen DL, Teerenstra S. Stepped wedge designs could reduce the required sample size in cluster randomized trials. J Clin Epidemiol. 2013 Jul;66(7):752-8. doi: 10.1016/j.jclinepi.2013.01.009. Epub 2013 Mar 22.
PMID: 23523551BACKGROUNDKim J, Parish AL. Polypharmacy and Medication Management in Older Adults. Nurs Clin North Am. 2017 Sep;52(3):457-468. doi: 10.1016/j.cnur.2017.04.007.
PMID: 28779826BACKGROUNDLavan AH, Gallagher P. Predicting risk of adverse drug reactions in older adults. Ther Adv Drug Saf. 2016 Feb;7(1):11-22. doi: 10.1177/2042098615615472.
PMID: 26834959BACKGROUNDBy the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015 Nov;63(11):2227-46. doi: 10.1111/jgs.13702. Epub 2015 Oct 8.
PMID: 26446832BACKGROUNDO'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015 Mar;44(2):213-8. doi: 10.1093/ageing/afu145. Epub 2014 Oct 16.
PMID: 25324330BACKGROUNDGallagher P, Barry P, O'Mahony D. Inappropriate prescribing in the elderly. J Clin Pharm Ther. 2007 Apr;32(2):113-21. doi: 10.1111/j.1365-2710.2007.00793.x.
PMID: 17381661BACKGROUNDGutierrez-Valencia M, Izquierdo M, Cesari M, Casas-Herrero A, Inzitari M, Martinez-Velilla N. The relationship between frailty and polypharmacy in older people: A systematic review. Br J Clin Pharmacol. 2018 Jul;84(7):1432-1444. doi: 10.1111/bcp.13590. Epub 2018 May 3.
PMID: 29575094BACKGROUNDThompson W, Farrell B. Deprescribing: what is it and what does the evidence tell us? Can J Hosp Pharm. 2013 May;66(3):201-2. doi: 10.4212/cjhp.v66i3.1261. No abstract available.
PMID: 23814291BACKGROUNDHemming K, Kasza J, Hooper R, Forbes A, Taljaard M. A tutorial on sample size calculation for multiple-period cluster randomized parallel, cross-over and stepped-wedge trials using the Shiny CRT Calculator. Int J Epidemiol. 2020 Jun 1;49(3):979-995. doi: 10.1093/ije/dyz237.
PMID: 32087011BACKGROUNDKim H, Park YH, Jung YI, Choi H, Lee S, Kim GS, Yang DW, Paik MC, Lee TJ. Evaluation of a technology-enhanced integrated care model for frail older persons: protocol of the SPEC study, a stepped-wedge cluster randomized trial in nursing homes. BMC Geriatr. 2017 Apr 18;17(1):88. doi: 10.1186/s12877-017-0459-7.
PMID: 28420324BACKGROUNDMcDonald EG, Estey JL, Davenport C, Bortolussi-Courval E, Gaudet J, Wilson Registe PP, Lee TC, Goodine C. Electronic Decision Support for Deprescribing in Older Adults Living in Long-Term Care: A Stepped-Wedge Cluster Randomized Trial. JAMA Netw Open. 2025 May 1;8(5):e2512931. doi: 10.1001/jamanetworkopen.2025.12931.
PMID: 40445620DERIVEDNadeau ME, Henry JL, Lee TC, Bortolussi-Courval E, Goodine C, McDonald EG. Spread and scale of an electronic deprescribing software to improve health outcomes of older adults living in nursing homes: study protocol for a stepped wedge cluster randomized trial. Trials. 2021 Nov 2;22(1):763. doi: 10.1186/s13063-021-05729-0.
PMID: 34727956DERIVED
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Carole Goodine, Pharm D
Horizon Health Network
- PRINCIPAL INVESTIGATOR
Emily McDonald, MD
McGill University Health Centre/Research Institute of the McGill University Health Centre
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- DOUBLE
- Who Masked
- INVESTIGATOR, OUTCOMES ASSESSOR
- Purpose
- SUPPORTIVE CARE
- Intervention Model
- SEQUENTIAL
- Sponsor Type
- OTHER
- Responsible Party
- SPONSOR
Study Record Dates
First Submitted
February 9, 2021
First Posted
February 21, 2021
Study Start
August 1, 2021
Primary Completion
July 31, 2022
Study Completion
October 31, 2022
Last Updated
June 16, 2021
Record last verified: 2021-02
Data Sharing
- IPD Sharing
- Will share
- Shared Documents
- STUDY PROTOCOL
- Time Frame
- Made available for 1 year following the publication of the primary manuscript from the trial.
- Access Criteria
- Contact study primary investigators at emily.mcdonald@mcgill.ca or Carole.goodine@horizonnb.ca
Non-pharma academic researchers may contact the principal investigator by email one year following the primary publication for access to data which will be shared via password-protected excel document.