Inappropriate Prescribing, Polypharmacy
Conditions
Keywords
Deprescribing, Inappropriate Medication, Nursing Homes
Brief summary
Older people residing in nursing homes (NH) are frequently polymedicated and often prescribed potentially inappropriate medications. Deprescribing has been proposed as a way to reduce the number of drugs they receive and their exposure to harmful treatments. The objectives of this study are 1) To evaluate the effect of a deprescribing-specific interdisciplinary quality circle module on the use of potentially inappropriate medication in nursing-home residents. 2) To determine the effective strategies to reach and implement deprescribing consensus resulting of said quality circle module.
Interventions
OTHERQuality Circle Deprescribing Module
The Quality Circle Deprescribing Module consist of a discussion bringing together nurses, physicians and responsible pharmacist to create a local deprescribing consensus for frequently used drug classes, as well as implementation strategies for the consensus..
Sponsors
Anne Niquille
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
Nursing homes taking part in the study must have * a geriatric of psycho-geriatric mission; * been part of their cantonal pharmaceutical assistance program for at least a year.
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Potentially Inappropriate Galenic Units | 12 months | The primary outcome is the percentage, at follow-up, of potentially inappropriate galenic units at follow-up, relative to the total number of galenic units used in the nursing home. |
| Number of Potentially Inappropriate Defined Daily Doses (DDDs) Per Average Resident and Per Day | 12 months | Sum of Defined Daily Doses identified as potentially inappropriate (PIM, see protocol for assessement method), divided by the total number of days spent in the NH |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Hospital Days | 12 months | The number of days spent in the hospital by average resident |
| Mortality Rate | 12 months | Number of residents of the nursing home having died during the considered year, divided by the total number of residents having stayed in the nursing home. |
| Number of Potentially Inappropriate DDD to Avoid | 12 months | Sum of Defined Daily Doses identified as to avoid (see protocol for assessement method), divided by the total number of days spent in the NH. |
| Percentage of Residents With at Least One Day of Physical Restraints Use | 12 months | Number of residents of the nursing home with at least one day of physical restraints use during the considered year, divided by the total number of residents having stayed in the nursing home. |
| Number of Falls Per Average Resident and Per Year | 12 months | Number of falls per average resident and per year |
| Number of Potentially Inappropriate DDD to Reevaluate | 12 months | Sum of Defined Daily Doses identified as to reevaluate (see protocol for assessement method), divided by the total number of days spent in the NH. |
Countries
Switzerland
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Intervention Nursing Homes allocated to the Intervention arm will enact the Quality Circle Deprescribing Module and create a local deprescribing consensus and implementation strategy.
Quality Circle Deprescribing Module: The Quality Circle Deprescribing Module consist of a discussion bringing together nurses, physicians and responsible pharmacist to create a local deprescribing consensus for frequently used drug classes, as well as implementation strategies for the consensus.. | 0 |
| Intervention Nursing Homes allocated to the Intervention arm will enact the Quality Circle Deprescribing Module and create a local deprescribing consensus and implementation strategy.
Quality Circle Deprescribing Module: The Quality Circle Deprescribing Module consist of a discussion bringing together nurses, physicians and responsible pharmacist to create a local deprescribing consensus for frequently used drug classes, as well as implementation strategies for the consensus.. | 27 |
| Control Nursing Homes allocated to the Control arm will not enact the intervention. | 0 |
| Control Nursing Homes allocated to the Control arm will not enact the intervention. | 29 |
| Total | 56 |
Baseline characteristics
| Characteristic | Control | Total | Intervention |
|---|---|---|---|
| Age, Customized n/a | NA Nursing home | NA Nursing home | NA Nursing home |
| Days in hospital | 2.5 Days | 2.5 Days | 2.7 Days |
| Mortality rate | 34 percent | 34 percent | 32 percent |
| NH mission Geriatric | 20 Nursing home | 36 Nursing home | 16 Nursing home |
| NH mission Psycho-geriatric | 9 Nursing home | 20 Nursing home | 11 Nursing home |
| Number of average residents | 35 Number of average residents | 43 Number of average residents | 48 Number of average residents |
| Number of falls | 2.3 Falls per avg. resident and per year | 2.3 Falls per avg. resident and per year | 2.3 Falls per avg. resident and per year |
| Number of potentially inappropriate DDD to avoid | 0.4 DDD per average resident and per day | 0.4 DDD per average resident and per day | 0.3 DDD per average resident and per day |
| Number of potentially inappropriate DDD to reevaluate | 2.1 DDD per average resident and per day | 2.0 DDD per average resident and per day | 1.9 DDD per average resident and per day |
| Overall number of potentially inappropriate DDD | 2.4 DDD per average resident and per day | 2.4 DDD per average resident and per day | 2.4 DDD per average resident and per day |
| Percentage of potentially inappropriate galenic units | 22 percent | 24 percent | 26 percent |
| Race/Ethnicity, Customized n/a | NA Nursing home | NA Nursing home | NA Nursing home |
| Rate of physical restraints use | 27 Percent | 24 Percent | 23 Percent |
| Region of Enrollment Switzerland | 29 participants | 56 participants | 27 participants |
| Sex/Gender, Customized n/a | NA Nursing home | NA Nursing home | NA Nursing home |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 921 / 2,899 | 717 / 2,113 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Number of Potentially Inappropriate Defined Daily Doses (DDDs) Per Average Resident and Per Day
Sum of Defined Daily Doses identified as potentially inappropriate (PIM, see protocol for assessement method), divided by the total number of days spent in the NH
Time frame: 12 months
Population: The analysis level is the nursing home; no data on individual residents were collected
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Number of Potentially Inappropriate Defined Daily Doses (DDDs) Per Average Resident and Per Day | 2.1 PIM DDD per avg resident per day | Standard Deviation 0.5 |
| Control | Number of Potentially Inappropriate Defined Daily Doses (DDDs) Per Average Resident and Per Day | 2.3 PIM DDD per avg resident per day | Standard Deviation 0.5 |
p-value: <0.0595% CI: [-0.39, 0.03]Regression, Linear
Primary
Percentage of Potentially Inappropriate Galenic Units
The primary outcome is the percentage, at follow-up, of potentially inappropriate galenic units at follow-up, relative to the total number of galenic units used in the nursing home.
Time frame: 12 months
Population: The analysis level is the nursing home; no data on individual residents were collected
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Percentage of Potentially Inappropriate Galenic Units | 24 percent | Standard Deviation 7 |
| Control | Percentage of Potentially Inappropriate Galenic Units | 23 percent | Standard Deviation 9 |
p-value: <0.0595% CI: [-3.8, 1]Regression, Linear
Secondary
Mortality Rate
Number of residents of the nursing home having died during the considered year, divided by the total number of residents having stayed in the nursing home.
Time frame: 12 months
Population: The analysis level is the nursing home; no data on individual residents were collected
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Mortality Rate | 31 Percent of residents having died | Standard Deviation 14 |
| Control | Mortality Rate | 38 Percent of residents having died | Standard Deviation 8 |
p-value: <0.0595% CI: [-21.5, -4]Regression, Linear
Secondary
Number of Falls Per Average Resident and Per Year
Number of falls per average resident and per year
Time frame: 12 months
Population: The analysis level is the nursing home; no data on individual residents were collected.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Number of Falls Per Average Resident and Per Year | 3.0 Falls per avg resident and per year | Standard Deviation 1.9 |
| Control | Number of Falls Per Average Resident and Per Year | 2.6 Falls per avg resident and per year | Standard Deviation 1.1 |
p-value: <0.0595% CI: [-0.754, 0.424]Regression, Linear
Secondary
Number of Hospital Days
The number of days spent in the hospital by average resident
Time frame: 12 months
Population: The analysis level is the nursing home; no data on individual residents were collected
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Number of Hospital Days | 3.1 Days per avg resident and per year | Standard Deviation 1.5 |
| Control | Number of Hospital Days | 2.5 Days per avg resident and per year | Standard Deviation 1.7 |
p-value: <0.0595% CI: [0.164, 2.938]Regression, Linear
Secondary
Number of Potentially Inappropriate DDD to Avoid
Sum of Defined Daily Doses identified as to avoid (see protocol for assessement method), divided by the total number of days spent in the NH.
Time frame: 12 months
Population: The analysis level is the nursing home; no data on individual residents were collected
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Number of Potentially Inappropriate DDD to Avoid | 0.3 Number of PIM DDD per avg resident | Standard Deviation 0.2 |
| Control | Number of Potentially Inappropriate DDD to Avoid | 0.3 Number of PIM DDD per avg resident | Standard Deviation 0.2 |
p-value: <0.0595% CI: [-0.095, 0.025]Regression, Linear
Secondary
Number of Potentially Inappropriate DDD to Reevaluate
Sum of Defined Daily Doses identified as to reevaluate (see protocol for assessement method), divided by the total number of days spent in the NH.
Time frame: 12 months
Population: The analysis level is the nursing home; no data on individual residents were collected
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Number of Potentially Inappropriate DDD to Reevaluate | 1.8 Number of PIM DDD per avg resident | Standard Deviation 0.5 |
| Control | Number of Potentially Inappropriate DDD to Reevaluate | 2.0 Number of PIM DDD per avg resident | Standard Deviation 0.5 |
p-value: <0.0595% CI: [-0.435, -0.04]Regression, Linear
Secondary
Percentage of Residents With at Least One Day of Physical Restraints Use
Number of residents of the nursing home with at least one day of physical restraints use during the considered year, divided by the total number of residents having stayed in the nursing home.
Time frame: 12 months
Population: The analysis level is the nursing home; no data on individual residents were collected.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Percentage of Residents With at Least One Day of Physical Restraints Use | 33 Proportion of res with phys restraints | Standard Deviation 27 |
| Control | Percentage of Residents With at Least One Day of Physical Restraints Use | 37 Proportion of res with phys restraints | Standard Deviation 23 |
p-value: <0.0595% CI: [-16, 7.6]Regression, Linear