Improving Medication Prescription in the Context of Advanced Care Planning for Patients Receiving Nursing Home Care

Status

Active, not recruiting

Phases

Unknown

Study type

Interventional

Source

NL-OMON

Registry ID

NL-OMON29679

Enrollment

480

Registered

2017-08-23

Start date

2018-03-01

Completion date

Unknown

Last updated

2024-02-28

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Prescribing practice for elderly nursing home patients with a limited life expectancy

Interventions

All NHs (intervention and control group) will be instructed in the inclusion procedure and the use of the online data registration tool. Before the trial, a Delphi consensus study will be conducted

Eligibility

Inclusion criteria

Inclusion criteria: - Elderly patients (age >=65 years ) - Residing in (University-affiliated) Nursing home, nursing home uses Ysis as Electronic medical Record - Patients residing on a long-term NH ward for somatic or psychogeriatric care - Having a permanent residence indication (¡Ã6 months, until the end of life) - Having an indication for geriatric-palliative care based on the Supportive & palliative Care Indicators Tool (SPICT) OR: Having a clear wish for a geriatric-palliative approach. - Written informed consent can be obtained (consent is given by the patient him-/herself or through a legal representative in case of legal incapability)

Exclusion criteria

Exclusion criteria: - Having an short-stay indication of less than six months - Being admitted for geriatric rehabilitation or hospice care (terminal care). - Patients residing on special care wards (e.g. mentally handicapped ward, young dementia ward, Acquired Brain Injury-ward, wards for specific diseases (Parkinson, Huntington, Korsakov)

Design outcomes

Primary

Measure	Time frame
Unless otherwise indicated, all outcome variables will be measured at T0-T3 both in the intervention group and the control group. Outcome name: change in prescription of preventive/chronic medication from: (among others) ATC main groups N (central nervous system), A (alimentary tract and metabolism) and C (cardiovascular System). Medication use per ATC (Anatomical Therapeutical Chemical Classification) group, number of DDD (daily defined dose) will be derived from the computer system of the NH pharmacists. Timepoint: T0-T3 (18 months after T0 inclusion) The study will focus on longitudinal change in individual medication use (allowing for intra patient comparisons), as well as on change in medication use of residents of a ward. To support data registration, online forms will be developed as part of a special electronic patient record-tool.	—

Measure

Time frame

Unless otherwise indicated, all outcome variables will be measured at T0-T3 both in the intervention group and the control group. Outcome name: change in prescription of preventive/chronic medication from: (among others) ATC main groups N (central nervous system), A (alimentary tract and metabolism) and C (cardiovascular System). Medication use per ATC (Anatomical Therapeutical Chemical Classification) group, number of DDD (daily defined dose) will be derived from the computer system of the NH pharmacists. Timepoint: T0-T3 (18 months after T0 inclusion) The study will focus on longitudinal change in individual medication use (allowing for intra patient comparisons), as well as on change in medication use of residents of a ward. To support data registration, online forms will be developed as part of a special electronic patient record-tool.

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Secondary

Measure	Time frame
1. Quality of life: measured with the EuroQoL (EQ-5D) proxy version. Timepoints: T0-3 2. Social wellbeing will be measured with the RISE (Revised Index for Social Engagement), derived from the RAI-LTCF (Resident Assessment Instrument for Long-Term Care Facilities). Timepoints: T0-3 3. Pain, measured with RAI-LCTF. Timepoints: T0-3 4. Experienced involvement in decision-making about medications by patients/surrogates will be measured by a questionnaire based on the SDM-Q9 for decision-making. Time-points T0-3 5. Frequency of falls in the last 90 days, measured with RAI-LCTF. Timepoint: T0-T3 6. Hospitalizations: cause, length of stay in days, derived from the electronic patient records. Timepoint: at T3 or when patient terminates the study (any cause) 7. Deaths (any cause). Timepoint: any timepoint 8. Appropriateness of medication prescription. This will be assessed by an expert panel consisting of members from the research team, supported by members of Ephor. Assessment will be on the basis of the following (anonymous patient) data: medical diagnoses, renal function, pain, overriding care goal (see secondary outcomes and additional measurements), and will be scored using the medication appropriateness indicators list developed in the Delphi study and the guidelines of the professional organization of elderly care physicians. Timepoint: T1-T3, after every SMMR. Additional measurements (including possible confounders): - Socio-demographic variables (sex, age) and length of stay in NH, from electronic patient records. Timepoint: T0 - Overriding care goal (geriatric-palliative care or other, from electronic patient records, Timepoint: T0-3 - Medical diagnoses, including recent renal function (GFR), from electronic patient records, Timepoint: T0-3 - Decisional capacity, measured with the RAI-LCTF. Timepoint: T0-3 - Demographic data on nursing home staff (physicians, pharmacists, nurses): age, sex, years of experience in nursing home setting. Timepoint:	—

Measure

Time frame

1. Quality of life: measured with the EuroQoL (EQ-5D) proxy version. Timepoints: T0-3 2. Social wellbeing will be measured with the RISE (Revised Index for Social Engagement), derived from the RAI-LTCF (Resident Assessment Instrument for Long-Term Care Facilities). Timepoints: T0-3 3. Pain, measured with RAI-LCTF. Timepoints: T0-3 4. Experienced involvement in decision-making about medications by patients/surrogates will be measured by a questionnaire based on the SDM-Q9 for decision-making. Time-points T0-3 5. Frequency of falls in the last 90 days, measured with RAI-LCTF. Timepoint: T0-T3 6. Hospitalizations: cause, length of stay in days, derived from the electronic patient records. Timepoint: at T3 or when patient terminates the study (any cause) 7. Deaths (any cause). Timepoint: any timepoint 8. Appropriateness of medication prescription. This will be assessed by an expert panel consisting of members from the research team, supported by members of Ephor. Assessment will be on the basis of the following (anonymous patient) data: medical diagnoses, renal function, pain, overriding care goal (see secondary outcomes and additional measurements), and will be scored using the medication appropriateness indicators list developed in the Delphi study and the guidelines of the professional organization of elderly care physicians. Timepoint: T1-T3, after every SMMR. Additional measurements (including possible confounders): - Socio-demographic variables (sex, age) and length of stay in NH, from electronic patient records. Timepoint: T0 - Overriding care goal (geriatric-palliative care or other, from electronic patient records, Timepoint: T0-3 - Medical diagnoses, including recent renal function (GFR), from electronic patient records, Timepoint: T0-3 - Decisional capacity, measured with the RAI-LCTF. Timepoint: T0-3 - Demographic data on nursing home staff (physicians, pharmacists, nurses): age, sex, years of experience in nursing home setting. Timepoint:

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Contacts

Public ContactC.A.M. (Karin) Pouw

Department of General Practice and Elderly Care Medicine

c.pouw@vumc.nl+31-(0)20-4445681

Outcome results

None listed

Source: NL-OMON (via WHO ICTRP)