Polypharmacy
Conditions
Keywords
deprescribing, polypharmacy, drug safety, randomized controlled trial, pharmacist, shared decision making, optimal prescribing
Brief summary
Older patients using many prescription drugs (hyperpolypharmacy) may be at increased risk of adverse drug effects. This randomized controlled trial tested the effectiveness and safety of a quality intervention intended to reduce hyperpolypharmacy. The study was set at Kaiser Permanente Northern California, an integrated health system with multiple pre-existing deprescribing workflows. Eligible patients were aged ≥76 years using ≥10 prescription medications. The intervention included physician-pharmacist collaborative drug therapy management, standard-of-care practice recommendations, shared decision-making, and deprescribing protocols administered by telephone over multiple cycles for a maximum of 180 days after allocation. A priori primary effectiveness endpoints included change in the number of medications and in the prevalence of geriatric syndrome from 181-365 days after allocation. Second endpoints included utilization and adverse drug withdrawal effects. Information was obtained from the electronic health record.
Interventions
OTHERBundled hyperpolypharmacy
Bundled hyperpolypharmacy playbook to be used by pharmacist, with physician approval, in shared decision making with participant,
Sponsors
Kaiser Permanente
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
76 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Kaiser Permanente patients * Age ≥76 years * ≥10 drugs (excluding topicals) where * drug filled ≥2 times in the past year and * drug last filled \< 180 days ago
Exclusion criteria
* less than 12 months preceding enrollment at Kaiser Permanente * no primary care practitioner assigned * on dialysis * history of heart, liver, lung, breast, or bone marrow transplant * in hospice * under active treatment for cancer during the past 12 months * has received an intervention through the Pharmacy Targeted Deprescribing Program in the preceding year.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in number of medications | Difference between (days 181-365 after randomization) and (180 days before randomization) | Change in number of dispensed medications recorded in the comprehensive, integrated pharmacy information system |
| Change in prevalence of geriatric syndrome | Difference between (days 181-365 after randomization) and (180 days before randomization) | Change in prevalence for any of the following: Falls (hip fracture, lower leg fracture, osteoporosis with fracture, pathologic fracture, osteonecrosis; gait; repeated falls; syncope; tripping; reduced mobility), Cognition (Somnolence; awareness; dizziness; malaise; Urinary incontinence (Unspecified urinary incontinence; retention of urine, unspecified; functional urinary incontinence; stress incontinence ; other specified urinary incontinence) and Pain (Drug induced headache; joint pain; muscle weakness, rhabdomyolysis, spas; myalgia) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Utilization | Difference between (days 181-365 after randomization) and (180 days before randomization) | Change in number of outpatient visits, inpatient visits, and emergency department visits. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Adverse drug withdrawal effects | Difference between (days 181-365 after randomization) and (180 days before randomization) | Change in prevalence of lower respiratory, cardiovascular, gastrointestinal, hyperuricemia, and elevated blood glucose |
Countries
United States
Outcome results
None listed