Deprescribing in a Long Term Care Facility

Impact of a Deprescribing Intervention on Nursing Home Residents: a Randomized Controlled Trial

This study will develop, implement and evaluate a deprescribing initiative at a Canadian Long Term Care (LTC) Facility. Residents currently undergo an annual medication review as part of the clinical pharmacy services provided in the LTC facility. For this study, eligible residents will be randomized to receive either a deprescribing focused medication review or usual care.

The deprescribing focused medication therapy assessments will be done on half of the 143 residents residing on the second and third floors of the facility. The other half of residents will serve as the control group and continue to receive their annual medication review and regular care from the attending physicians and nurses.

The deprescribing intervention will be delivered by final year pharmacy students completing their practice experiences, under the supervision of clinical pharmacists at the LTC facility and clinical pharmacists from Memorial University's Medication Therapy Services (MTS) Clinic. Currently the clinic has a well developed procedure for providing in depth medication therapy reviews for residents of the community, upon referral by their primary care physician. Students will adapt this model of medication review to have a stronger deprescribing focus and be applicable to elderly residents of a LTC facility. The intervention will consist of an in depth medication therapy review with a focus on identifying any medications that may no longer be required or are deemed to be inappropriate or potentially unsafe in the elderly based on currently guidelines/criteria. The students will work closely with members of the resident's care team on a daily basis, as well as the resident and their family, to develop and implement a deprescribing plan.

Study Overview

• Status: Completed
• Conditions: Polypharmacy
• Intervention / Treatment: Other: Medication Review

• Study Type: Interventional
• Enrollment (Actual): 67
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Newfoundland and Labrador
    • St. John's, Newfoundland and Labrador, Canada
      • St Patrick's Mercy Home

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria (all of the following):

1. Over 65 years of age
2. Reside in St. Patrick's Mercy Home (2nd or 3rd floor units)

Exclusion Criteria (any of the following):

1. Do not take any regularly scheduled medications
2. Are receiving palliative care
3. Resident's physician or nursing team do not support participation
4. Resident or their substitute decision maker decline participation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; Standard care. Annual medication review
Experimental: Intervention; In depth medication review with a focus on deprescribing	Other: Medication Review; In depth medication review with a focus on deprescribing

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in number of medications taken daily by residents	Measured using facility medication logs and patient health records	3 and 6 months after receiving intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
All cause mortality rate	Measured using patient health records	3 and 6 months after receiving the intervention
Instance of falls in the last 30 days	Measured using facility fall report logs	3 and 6 months after receiving the intervention
Frequency of emergency room visits, unplanned hospital admission and/or unplanned GP visits	Measured using patient health records	3 and 6 months after receiving the intervention
Cognitive function score	Measured using Cognitive Performance Scale (CPS) obtained from Resident Assessment Instrument (RAI) MDS 2.0	3 and 6 months after receiving the intervention
Bowel function	Measured using bowel chart data for the 14 days prior to the assessment date	baseline, 3 and 6 months after receiving the intervention
Independence in activities of daily living	Measured using the Activities of Daily Living Scale (ADL) obtained from RAI MDS 2.0	3 and 6 months after receiving the intervention
Changes in general health	Measured using the Changes in Health, End-Stage Disease and Signs and Symptoms (CHESS) Score obtained from RAI MDS 2.0	3 and 6 months after receiving the intervention
Social engagement	Measured using Index of Social Engagement (ISE) Score obtained from RAI MDS 2.0	3 and 6 months after receiving the intervention
Aggressive behaviour	Measured using the Aggressive Behaviour Scale (ABS) obtained from RAI MDS 2.0	3 and 6 months after receiving the intervention
Frequency of pain	Measured using the Pain Scale obtained from RAI MDS 2.0	3 and 6 months after receiving the intervention

Collaborators and Investigators

• Sponsor: Memorial University of Newfoundland
• Collaborators: Eastern Health
• Investigators: Principal Investigator: Deborah Kelly, PharmD, Memorial University of Newfoundland

Study record dates

Study Major Dates

• Study Start (Actual): March 30, 2017
• Primary Completion (Actual): December 31, 2018
• Study Completion (Actual): June 1, 2019

Study Registration Dates

• First Submitted: March 21, 2017
• First Submitted That Met QC Criteria: March 21, 2017
• First Posted (Actual): March 27, 2017

Study Record Updates

• Last Update Posted (Actual): July 22, 2019
• Last Update Submitted That Met QC Criteria: July 19, 2019
• Last Verified: July 1, 2019

More Information

Terms related to this study

• Other Study ID Numbers: HREB - 2016.312

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No