Dementia, Mild Cognitive Impairment (MCI), Potentially Inappropriate Medication Use
Conditions
Keywords
deprescribing, polypharmacy, potentially inappropriate medications, dementia, cognitive impairment
Brief summary
The overarching goal of this study is to pilot an intervention in which older adults with mild cognitive impairment and dementia and the older adult's care partners are identified in primary care and provided with educational materials through the patient portal to engage the participant in deprescribing. The multicomponent intervention, e-Align, includes delivery of educational information through the patient portal, and a pharmacist-led intervention to align medications with patient and care partner goals and reduce use of central nervous system (CNS) potentially inappropriate medicines (PIM). This work will establish the preliminary data, methods, and partnerships to undertake a multisite embedded pragmatic clinical trial. The resulting triadic-based behavioral intervention will promote patient and care partner engagement, and foster care that aligns with patients' values, and promote improved health and well-being outcomes for people with cognitive impairment and the patient's care partners through deprescribing.
Interventions
OTHERe-ALIGN Patient-Portal Deprescribing
The intervention will consist of educational materials about deprescribing, which will be sent to the patient prior to the scheduled primary care visit.
Sponsors
Johns Hopkins University
National Institute on Aging (NIA)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Masking description
Due to the nature of the intervention, participants cannot be masked.
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Patients: Age ≥65, with a diagnosis of MCI or dementia based on ICD-10 codes and ≥1 active CNS-PIM, who are active patient portal users. Care partners: * Family or other companions \>21 years who regularly help the patient with managing medications.
Exclusion criteria
* As the trial will be based in primary care, individuals residing in long term care facilities or enrolled in hospice will be excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of patients who open the patient portal message | 1 month after sending message | The investigators will assess the number of patients and/or care partners who read the patient portal message sent by the study team, which invites the participant to meet with a clinical pharmacist for deprescribing. |
| Number of patients who watch the video | 1 month after sending message | The investigators will assess the number of patients who click and watch the educational video about CNS-PIM and deprescribing. |
| Acceptability of educational video assessed by survey | 1 month after sending message | The investigators will assess the acceptability of the educational video by administering a survey to participants. The survey will ask participants to rate various features of the video on a 5-point Likert scale, where a higher score indicates greater acceptability. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of patients or care partners that discussed deprescribing with any clinicians after receiving the message | 3 months after sending message | Study team will follow up to assess if deprescribing was discussed with a clinician after receiving the patient portal message by conducting a review of patients' chart. |
| Number of PCPs who send the referral | 3 months after sending message | Study team will assess how many PCPs send a referral to clinical pharmacy for patients who have been identified as candidates for deprescribing. |
| Number of patients who schedule the pharmacist visit | 3 months after sending message | The investigators will determine the number of patients and/or care partners who schedule a visit with a clinical pharmacist for deprescribing CNS-PIM following receipt of the patient portal message. |
| Number of patients who deprescribe ≥1 CNS-PIM after receiving the message | 3 months after sending message (for patients who do NOT have a pharmacist visit) | For those who do not schedule a pharmacist visit, the investigators will evaluate the number of patients who deprescribed at least 1 CNS-PIM after receiving the patient portal message. |
| Number of patients who start ≥1 CNS-PIM after receiving the message | 3 months after sending message (for people who do NOT have a pharmacist visit) | For those who do not schedule a pharmacist visit, the investigators will evaluate the number of patients who add at least 1 CNS-PIM to the medication regimen after receiving the patient portal message. |
Countries
United States
Contacts
CONTACTAriel Green, MD, MPH, PhD
PRINCIPAL_INVESTIGATORAriel Green, MD, MPH, PhD
Johns Hopkins University
Outcome results
None listed