None listed
Conditions
Brief summary
Our study aimed to assess the effectiveness of the Physician-Pharmacist Partnership Intervention for Deprescribing (P3ID) among older persons attending a falls and syncope clinic. This randomised controlled trial will be conducted at a teaching hospital in Kuala Lumpur, Malaysia. Participants will involve individuals aged 60 years and over with multiple chronic diseases, prescribed oen or more medications with one or more potentially inappropriate medication (PIM) and attending physicians at the clinic. The joint pharmacist-physician intervention comprises five steps: 1) PIM identification, 2) decision on cessation and prioritisation, 3) medication withdrawal, 4) monitoring and support, 5) and documentation.
Interventions
Participants in the intervention group will receive an in-depth medication review of approximately 30 minutes performed by a pharmacist, which will focus on identifying PIMs as opportunities for deprescribing. In the intervention group, PIMs identified will be deprescribed using the P3ID intervention. P3ID intervention consists of 5 steps:
Step 1: PIM identification
a) Participant selection
Researcher reviews electronic medical record (EMR) before follow-up to obtain medication list and ident
Participants in the intervention group will receive an in-depth medication review of approximately 30 minutes performed by a pharmacist, which will focus on identifying PIMs as opportunities for deprescribing. In the intervention group, PIMs identified will be deprescribed using the P3ID intervention. P3ID intervention consists of 5 steps: Step 1: PIM identification a) Participant selection Researcher reviews electronic medical record (EMR) before follow-up to obtain medication list and identify any potentially inappropriate medications (PIMs). The researcher will then contact selected potential participants, asking them to arrive an hour before their scheduled appointment at the clinic and reminding them to bring their medications for review. b) Medication review The participant completes the written consent form and a baseline demographic questionnaire, Patients were then asked to complete the Patient Medication Adherence Instrument (PMAI-9), a self-reported measure designed to assess medication adherence from the patient's perspective. The pharmacist conducts a medication review using the STOPPFall criteria to identify PIMs and asks about any medication-related issues and self-monitoring practices (e.g., blood pressure or glucose levels). The pharmacist then completes the Healthcare professional-Medication Adherence Instrument (HMAI-9), a self-reported tool designed to evaluate medication adherence from the healthcare professional's perspective. Step 2: Decisions on prioritization on cessation Algorithm for deciding order and mode in which drug use could be discontinued will be applied to determine deprescribing strategy. Step 3: Medication withdrawal a) Physician-pharmacist discussion Pharmacist discusses deprescribing opportunities with physician. b) Doctor-patient consultation If physicians decides to deprescribe, discussion is held with patients Step 4: Monitoring and support a) Doctor’s feedback to the pharmacist Physician will inform the pharmacist of patients’ latest medication regimen b) Medication counselling Pharmacist counsel patients and reinforce instructions given by physician. Step 5: Documentation Physician documents consultation and shared decision at EMR
Sponsors
Universiti Malaya-Department of Medicine Research Support Fund, Faculty of Medicine
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1)Patients: Individuals aged 60 years and over with at least one chronic disease requiring pharmacological treatment and prescribed one or more medications, attending the falls and syncope clinic with one or more PIM according to the STOPPFall criteria. For those who may lack mental capacity, assent will be obtained from their next of kin. Since medication review and deprescribing are generally considered appropriate for older adults, no exclusion criteria are anticipated 2) Doctors: Geriatricians, internal and family physicians undergoing subspecialty training in geriatric medicine and medical officers working at the centre will be recruited.
Exclusion criteria
1) Patients For patients who may lack mental capacity, consent will be sought from the physician overseeing the participant’s care, who will also be recruited into the study. If the physician determines that participation in the RCT is unsuitable for the participant based on clinical judgment, the participant will be excluded. Additionally, if a potential participant’s physician declines to participate and the participant chooses to remain under their care, the participant will also be excluded. 2) Doctors Doctors who declined to participate in the study
Outcome results
None listed