- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04077281
Improving Medication Prescribing-Related Outcomes for Vulnerable Elderly In Transitions (IMPROVE-IT)
November 20, 2023 updated by: Dr. Anne Holbrook, St. Joseph's Healthcare Hamilton
Improving Medication Prescribing-Related Outcomes for Vulnerable Elderly In Transitions (IMPROVE-IT): A Pilot Randomized Trial
Medication safety is a crucial health issue for every older Canadian since many of the medications causing serious harm are those which also have life-saving or important symptom-relieving benefits.
Very few specialists can accurately advise seniors which medications provide more benefit than harm for them personally, and make changes safely as this requires a very large breadth and depth of knowledge about the patient, the conditions they have and their therapies.
Now that telemedicine is compatible with smart phones, this extends the ability of scarce specialists to 'see' any patient in Canada in a way that is more convenient for the patient and may be less expensive than current care.
This project will find out whether a unique Clinical Pharmacology specialist team in Hamilton, Ontario can improve medication safety (stop medications no longer needed, reduce doses where appropriate, change to safer medications) for a high risk group of older hospitalized Canadians taking many medications.
The hospital where this pilot study will take place was the first to install the world's leading electronic health record and set it up to facilitate and support high quality research.
Patients who volunteer will be assigned to their usual care, or to the intervention which is the Clinical Pharmacology specialist team approach starting in hospital and following up with the patient at home using telemedicine and detailed communication with them, their caregiver, family physician, community pharmacist and other specialists.
The investigators will study whether the intervention is effective and cost-effective at reducing harmful medication burden, reducing the need to return to hospital, or improving the patient's ratings of their care coordination.
The results will determine whether a subsequent large trial is worthwhile.
Study Overview
Status
Recruiting
Intervention / Treatment
Study Type
Interventional
Enrollment (Estimated)
300
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Anne Holbrook
- Phone Number: 35269 905-522-1155
- Email: holbrook@mcmaster.ca
Study Contact Backup
- Name: Victoria Telford
- Phone Number: 35269 905-522-1155
- Email: vtelford@stjoes.ca
Study Locations
-
-
Ontario
-
Hamilton, Ontario, Canada, L8N 4A6
- Recruiting
- St. Joseph's Healthcare Hamilton
-
Contact:
- Victoria Telford
- Phone Number: 35269 905-522-1155
- Email: vtelford@stjoes.ca
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
65 years and older (Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Adults over the age of 65 years.
- Admitted to Medicine or Surgery services for more than 2 days.
- High cost users (defined as):
- Have at least one other hospitalization within the previous year.
- Taking 5 or more chronic medications including at least one TRIIM-Med.
- Provide informed consent.
Exclusion Criteria:
- Patients with "do not approach status".
- Patient or Caregiver not fluent in English.
- Patients who do not provide informed consent.
- Patients admitted for < 2 days.
- Patients < 65 years of age.
- Not a high cost user (as defined above).
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intervention Arm
Clinical Pharmacology specialist team approach starting in hospital and following up with the patient at home using telemedicine and detailed communication with them, their caregiver, family physician, community pharmacist and other specialists.
|
|
No Intervention: Control Arm (Usual care)
Patients will receive a best possible medication history (BPMH) as do the intervention patients, then usual care by their primary team.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility Outcome: Recruitment rate for eligible patients.
Time Frame: Through the study completion, an average of 2 years
|
The main trial will be considered feasible if we are able to recruit at least 50% of eligible patients in this pilot.
|
Through the study completion, an average of 2 years
|
Clinical Outcome: The number of TRIIM-Meds successfully deprescribed.
Time Frame: 2 months post discharge
|
The number of TRIIM-Meds successfully deprescribed (dose reduction or discontinued) at 2 months post-hospital discharge, aiming to be able to detect a mean difference of 0.5.
|
2 months post discharge
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility Outcomes of CPT consultation volume capacity and potential to apply the intervention entirely through telemedicine.
Time Frame: Through the study completion, an average of 2 years
|
This will be measured based on the number of successfully enrolled patients, and the number of patients that will entirely undergo the intervention through telemedicine.
|
Through the study completion, an average of 2 years
|
Feasibility Outcomes of patient retention rate.
Time Frame: Through the study completion, an average of 2 years
|
This will be measured by looking at the number of patients enrolled, the number of patients that dropped out, and the number of patients that completed the study.
|
Through the study completion, an average of 2 years
|
Feasibility Outcomes of likelihood of the intervention proving cost-effective.
Time Frame: Through the study completion, an average of 2 years
|
This will be measured using Healthcare resource utilization questionnaire, which will determine whether the intervention reduced healthcare costs compared to the control group.
|
Through the study completion, an average of 2 years
|
Patient-important outcomes: Participant ratings of coordination and continuity of transitions in care.
Time Frame: 2 months post discharge
|
This outcome will be measured using the Coordination and Continuity of Care Questionnaire (CCCQ).
Which is a questionnaire we adapted from the brief prepared questionnaire (B-PREPARED) and the three-question care transitions measure questionnaire (CTM-3).
|
2 months post discharge
|
Patient-important outcomes: Health related quality of life: EQ-5D-5L
Time Frame: 2 months post discharge
|
This outcome will be measured using the EuroQol five-dimensional, five-level descriptive system (EQ-5D-5L) that asks patients to self-assess their own health quality related quality of life.
Whereas a scoring metric is used to assess the overall health related quality of life based on the answers to the questions.
The questionnaire scale considers 1 as the best possible health and 5 as the worst health possible.
|
2 months post discharge
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Anne Holbrook, St. Joseph's Healthcare Hamilton
- Principal Investigator: Anne Holbrook, SJHH
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
June 1, 2023
Primary Completion (Estimated)
November 19, 2024
Study Completion (Estimated)
December 1, 2024
Study Registration Dates
First Submitted
August 7, 2019
First Submitted That Met QC Criteria
September 3, 2019
First Posted (Actual)
September 4, 2019
Study Record Updates
Last Update Posted (Actual)
November 22, 2023
Last Update Submitted That Met QC Criteria
November 20, 2023
Last Verified
November 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- CIHR#419518
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
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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