Deprescribing Potentially Inappropriate Medications in the Emergency Department for Persons Living With Dementia

NCT06273917 | Completed DMC

• 1 other identifier: FY23_Pilot2_Dresden
• Study Type: interventional
• Target: 300
• Locations: 1 country
• Sites: 3

Brief Summary

Aim 1: To demonstrate the feasibility by determining proportion of completed medication reconciliation, Central Nervous System active Potentially Inappropriate Medication (CNS PIM) use among patients with Alzheimer's Disease and Related Dementias (ADRD) and Mild Cognitive Impairment (MCI) in the emergency department (ED), and communication between ED clinical pharmacists and outpatient prescribers. Aim 2: To demonstrate the feasibility of collecting the primary and secondary outcomes for a subsequent study. The future primary outcome will be reduction in CNS PIMs 90 days after an ED visit. Secondary outcomes will include outpatient follow-up, repeat ED visits, and hospitalizations during the 90 days following an ED visit. Aim 3: To demonstrate the acceptability of the PRIDE intervention to outpatient clinicians using the Acceptability of Intervention Measure and qualitative analysis of responses.

Conditions

Dementia

Keywords

Depresribing Medication

Outcome Measures

Primary Outcomes (1)

• Pharmacist communication of deprescribing recommendation

  This will be determined if the ED pharmacist sends an electronic message through the EHR to the outpatient prescriber with de-prescribing recommendations for patients who are taking CNS PIMs. This will be performed on Day 0 in the Emergency Department.

  24 hours

Secondary Outcomes (4)

• Medication reconciliation

  24 hours

• Medication supply of CNS PIMs

  90 days

• Outpatient follow up

  90 days

• Repeat Emergency Department visits

  90 days

Study Arms (1)

PRIDE Patients

EXPERIMENTAL

Community-dwelling adults (age 18+) in the ED with prior outpatient visits within the NM system and a history of dementia or mild cognitive impairment recorded in the NM EHR will be eligible for inclusion. We will include 290 patients across 3 sites to have medication reconciliation conducted by the clinical pharmacist. Patients who were previously prescribed CNS PIMs will have deprescribing recommendations communicated by the clinical pharmacist to the outpatient prescriber.

Other: PRIDE

Interventions

PRIDE OTHER

Pharmacists present in the ED will perform medication reconciliation for eligible patients. This will be done to demonstrate the feasibility of the PRIDE intervention in the ED for patients with ADRD and MCI. Patients eligible for medication reconciliation will be enrolled in Aim 2 of the study. Outpatient prescribers of these patients who are discharged from the ED will be contacted by the ED pharmacist on the date of ED discharge and will receive a medication report including fill data 90-100 days after the ED visit. At the completion of the study, the outpatient clinicians will also receive a questionnaire about the acceptability of the PRIDE program including the Acceptability of Intervention Measure to complete electronically.

PRIDE Patients

Eligibility Criteria

• Age: 18 Years - 120 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Community dwelling
• years of age or older
• History of dementia or mild cognitive impairment in the problem list in the NM EHR. A history of mild cognitive impairment will be identified using the ICD-10 code G31.84 (mild cognitive impairment) or ICD-10 codes suggestive of ADRD as described in the Bynum-standard algorithm: F01.50-F01.51 (vascular dementia), F02.80-F02.81 (dementia), F03.90-F03.91 (unspecified dementia), F04 (amnestic disorder), G30.0/30.1/30.8/G30.9 (Alzheimer's disease), G31.01 (Pick's disease), G31.09 (frontotemporal dementia), G31.83 (dementia with Lewy bodies), G31.1 (senile degeneration), G31.2 (degeneration of nervous system), R41.81 (age-related cognitive decline).
• Able to participate in medication reconciliation as determined by the pharmacist per usual care OR a care partner with knowledge of the patient's current medications is present in the ED or is available by phone.
• Has had prior outpatient care performed at Northwestern Medicine location(s)
• Arrives to the emergency department between 7am and 7pm, Monday-Friday

You may not qualify if:

• Emergency Severity Index (ESI) of 1 (critical)
• ICU consult placed in the ED
• Reside in nursing facility or assisted living facility

Sponsors & Collaborators

• National Institute on Aging (NIA): lead
• Brown University: collaborator

Study Sites (3)

Northwestern Memorial Hospital

Chicago, Illinois, 60611, United States

Location

Northwestern Medicine Lake Forest Hospital

Lake Forest, Illinois, 60045, United States

Location

Northwestern Medicine Palos Hospital

Palos Heights, Illinois, 60463, United States

Location

Related Publications (20)

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MeSH Terms

Conditions

Dementia

Condition Hierarchy (Ancestors)

Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Mental Disorders

Study Officials

• Scott Dresden, Dr.

  Northwestern University- Department of Emergency Medicine

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: NIH
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Dr. Scott Dresden

Study Record Dates

• First Submitted: February 5, 2024
• First Posted: February 23, 2024
• Study Start: July 9, 2024
• Primary Completion: October 31, 2025
• Study Completion: October 31, 2025
• Last Updated: November 4, 2025

Record last verified: 2025-10

Data Sharing

• IPD Sharing: Will not share

Locations

US (3)