Deprescribing, Multi-disciplinary, Rounds
Conditions
Keywords
deprescribe, multi-disciplinary, open label, rounds, randomised controlled trial
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.
Detailed description
ABSTRACT BACKGROUND: Deprescribing has been effective and safe in reducing polypharmacy and morbidity (e.g. fall), especially amongst elderly. However, little has been studied about the efficacy of a regular multidisciplinary round in deprescribing predefined medications in Singapore rehabilitative hospitals. AIM: This study aims to evaluating the effects of a weekly multidisciplinary team(MDT) de-prescribing round on the reduction on total daily dose, cost of medications, its safety and feasibility in a Singapore rehabilitative hospital. Methods: A total of 260 newly admitted patients will be randomised to a de-prescribing intervention (n= 130) or control (usual care) group (n= 130), using GraphPad randomization sequence software ©2017. The 5 steps of deprescribing process will be used and the targets of deprescribing are Beer's list of potentially inappropriate medications (AGS 2015 version), predetermined supplements and symptomatic medications. Predetermined medications were deprescribed following initial MDT assessment, discussion with attending doctors and consideration of patients' preferences regarding discontinuation or dose reduction. Total daily dose reduction, cost and side effects of deprescribing were monitored on admission day 14, 28, discharge day and post-discharge day 28. Time required for such rounds are also measured. IMPACT: Once proven successful, this effective model of deprescribing could safely help to cut down caregiver's medicine administrative burden, improve compliance and reduce national healthcare cost. This model could also be easily replicated in all Singapore rehabilitative hospitals.
Interventions
OTHERWeekly MDT deprescribing rounds for certain drugs
* 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
Sponsors
Bright Vision Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
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)
Eligibility
Sex/Gender
ALL
Age
65 Years to 120 Years
Healthy volunteers
Yes
Inclusion criteria
* Greater or equals to 65 years old * Newly admitted to rehabilitation or sub-acute disciplines * Possess 1 or more of the targeted medications
Exclusion criteria
* Abbreviated mental test less than 7 * No mental capacity
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 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) | Change in total daily dose of medication upon discharge from the hospital |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 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. | Cost savings measured in Singapore dollars |
| 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. | Number of participants with side effects from deprescribing (i.e. recurrence of medical indications or symptoms; withdrawal effects of deprescribing; reinstating the same medications or substituting another medication, hospitalization and death) |
| 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) | The feasibility of implementation of intervention will also be determined through the time required to complete the de-prescribing process, measured in minutes. |
| 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) | The feasibility of implementation of intervention will also be determined through limitations and challenges encountered, as documented by the multidisciplinary team. |
Countries
Singapore
Outcome results
None listed