- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04938648
Aligning Medications With What Matters Most (ALIGN)
Align: Aligning Medications With What Matters Most
Study Overview
Status
Intervention / Treatment
Detailed Description
People living with dementia (PLWD) use more medications and have more complex medication regimens than people without dementia. Medication regimen complexity is a major source of burden for family caregivers of PLWD and has been associated with numerous adverse outcomes. Therefore, the investigators propose a novel intervention, ALIGN: Aligning Medications with What Matters Most, to optimize prescribing and reduce medication regimen complexity by focusing on what matters most to the patient and caregiver, beyond rigid adherence to clinical practice guidelines. ALIGN is informed by learnings from OPTIMIZE, the investigator team's patient-centered, pragmatic deprescribing intervention for PLWD in primary care that is currently being prospectively evaluated. OPTIMIZE consists of a patient-level intervention comprised of a deprescribing educational brochure, and a clinician-level intervention comprised of a deprescribing educational session for primary care providers (PCPs), deprescribing "tip sheets" and clinic-level feedback on rates of potentially inappropriate medication prescribing in PLWD. ALIGN builds on OPTIMIZE by more explicitly addressing the informational and decisional needs of caregivers through a shared decision making process facilitated by clinical pharmacists. The investigators propose a pilot study to assess the feasibility and acceptability of ALIGN in two different health care systems, and to identify the most appropriate primary outcome measure for a subsequent embedded pragmatic trial (ePCT). Target enrollment is 60 patient-care partner dyads. Patients will be aged ≥65 years with dementia and >5 chronic medications. Primary outcomes are intervention feasibility and acceptability among patients, care partners and PCPs; and feasibility of the patient-level Medication Regimen Complexity Index and Family Caregiver Medication Administration Hassles Scale at baseline and 3 months. Findings from this pilot study will guide the design, implementation and subsequent evaluation of ALIGN in an ePCT, laying the groundwork to reduce medication regimen complexity and burden for PLWD and their caregivers in diverse primary care settings.
This proposed pragmatic intervention has the following aims:
Specific Aim 1: To assess the feasibility and acceptability of ALIGN in two different health care systems, to guide the subsequent evaluation of the effectiveness of the intervention in an embedded pragmatic trial (ePCT).
Specific Aim 2: To determine the feasibility of the primary and secondary outcome measures for the subsequent ePCT.
- To determine the feasibility of measuring the primary outcome, the patient-level Medication Regimen Complexity Index (pMRCI), within the existing electronic health record (EHR) systems, and to compare it with a more pragmatic measure, chronic medication count, as the primary outcome measure for the ePCT.
- To determine the feasibility of measuring the secondary outcome, the Family Caregiver Medication Administration Hassles Scale (FCMAHS), a caregiver-reported outcome measure.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Colorado
-
Aurora, Colorado, United States, 80014
- Kaiser Permanente
-
-
Maryland
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Baltimore, Maryland, United States, 21224
- Johns Hopkins Bayview Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age 65 or greater
- Diagnosis of dementia from International Classification of Diseases (ICD) -9 or ICD-10 codes
- At least one other chronic condition
- Five or more chronic medications (to include all prescription and over-the-counter medications, both scheduled and as needed)
- Have a primary care physician at the pilot clinic who has enrolled in the study; this will be defined as having had at least 1 previous visit with that physician
Care partners:
- Family or other companions age 21 years or greater who regularly help the patient with managing medications
Exclusion Criteria:
- As both the pilot and the planned pragmatic trial will be based in primary care, individuals residing in long term care facilities or enrolled in hospice will be excluded.
- Individuals who cannot converse comfortably in English will be excluded because the FCMAHS has not been validated in other languages.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intervention
The intervention consists of the following:
|
1) direct-to-consumer deprescribing educational materials designed to activate the care partner and people living with dementia PLWD; 2) a telehealth visit in which a clinical pharmacist discusses benefits and harms of the patient's medications with the patient and care partner in the context of their goals and preferences; and 3) pharmacist-PCP communication in which the pharmacist provides tailored deprescribing recommendations designed to be useful and actionable for the PCP
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Active Comparator: Delayed Intervention (wait list control)
The delayed intervention consists of the following:
|
1) direct-to-consumer deprescribing educational materials designed to activate the care partner and people living with dementia PLWD; 2) a telehealth visit in which a clinical pharmacist discusses benefits and harms of the patient's medications with the patient and care partner in the context of their goals and preferences; and 3) pharmacist-PCP communication in which the pharmacist provides tailored deprescribing recommendations designed to be useful and actionable for the PCP
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility as Assessed by Proportion of Dyads That Opt Out of the Intervention
Time Frame: A duration of approximately 8 months
|
Dyads are comprised of the person living with dementia and their care partner.
We will measure the proportion of dyads that opt out of the intervention versus the dyads that agree to participate.
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A duration of approximately 8 months
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Feasibility as Assessed by the Number of Pharmacist Messages to the Primary Care Provider (PCP) That Receive an Acknowledgment or Response
Time Frame: 3 months after enrollment
|
We will measure the number of pharmacist's messages that receive an acknowledgment or response from the PCP based on Electronic Medical Record (EMR) review
|
3 months after enrollment
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Feasibility as Assessed by the Number of Contacts Between Pharmacist and PCP
Time Frame: 3 months after enrollment
|
We will measure the number of contacts between pharmacist and PCP based on Electronic Medical Record (EMR) review
|
3 months after enrollment
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Feasibility as Assessed by the Number of Contacts Between Pharmacist and Dyad
Time Frame: 3 months after enrollment
|
We will measure the number of contacts between pharmacist and PCP and dyad based on Electronic Medical Record (EMR) review
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3 months after enrollment
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Feasibility as Assessed by the Direct Time Required by the Pharmacist to Complete the Intervention
Time Frame: 3 months after enrollment
|
We will measure the amount of direct time that it takes the pharmacist to complete the intervention.
We will access from pharmacist's documentation in the Electronic Medical Record (EMR).
|
3 months after enrollment
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Feasibility as Assessed by the Indirect Time Required by the Pharmacist to Complete the Intervention
Time Frame: 3 months after enrollment
|
We will measure the amount of indirect time that it takes the pharmacist to complete the intervention.
We will access from pharmacist's documentation in the Electronic Medical Record (EMR).
|
3 months after enrollment
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Feasibility as Assessed by Percentage of Dyads Who Complete 2 of 2 Pharmacist Phone Calls Based on Documented Status Reports
Time Frame: Baseline and 3 months after enrollment
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Dyads are comprised of the person living with dementia and their care partner.
We will measure the percentage of dyads who complete 2 of 2 pharmacist phone calls based on documented status reports
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Baseline and 3 months after enrollment
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Acceptability Will be Assessed by the Acceptance Rates for the Pharmacist's Recommendations
Time Frame: 3 months after enrollment
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We will measure the acceptance rates for the pharmacist's recommendations as documented in the Electronic Medical Record (EMR)
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3 months after enrollment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Family Caregiver Medication Administration Hassles Scale (FCMAHS)
Time Frame: Baseline and 3 months after enrollment
|
The FCMAHS is a validated caregiver-reported outcome measure that assesses burden associated with medication administration.
The instrument consists of 24 items and four subscales: Information Seeking/Information Sharing (9 items), Safety Issues (5 items), Scheduling Logistics (7 items) and Polypharmacy (3 items).
The total score range is 0-120 with higher scores indicating greater perceived hassle associated with managing some or all aspects of another person's medication regimen.
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Baseline and 3 months after enrollment
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Total Medication Count
Time Frame: Baseline and 3 months after enrollment
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We will measure the total medication count using data obtained from the EHR.
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Baseline and 3 months after enrollment
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Percentage of Participants With Data Elements Available to Calculate the Medication Regimen Complexity Index (pMRCI)
Time Frame: Baseline and 3 months after enrollment
|
The feasibility of measuring this outcome will be determined as follows: Percentage of participants with data elements available vs. unavailable to calculate the pMRCI, within the existing electronic medical record systems. This study assessed the feasibility of measuring the pMRCI and not actually determining the pMRCI. The pMRCI is a validated, widely-used tool that measures medication regimen complexity to identify patients with expected difficulty managing their regimens. Scores are derived from weighted values of regimen components (eg, dosage formulations, frequencies, and specific instructions for use). Higher scores indicate greater medication regimen complexity. |
Baseline and 3 months after enrollment
|
Medication Regimen Complexity Index (MRCI)
Time Frame: Baseline and 3 months Baseline and 3 months after enrollment
|
The MRCI is a validated, widely-used tool that measures medication regimen complexity to identify patients with expected difficulty managing their regimens.
The MRCI score is derived from weighted values of regimen components (eg, dosage formulations, frequencies, and specific instructions for use).
The score has no upper limit, but higher scores indicate greater medication regimen complexity.
Regimen components were combined to compute a total score and averaged.
|
Baseline and 3 months Baseline and 3 months after enrollment
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Response Rate for the Family Caregiver Medication Administration Hassles Scale (FCMAHS)
Time Frame: Baseline and 3 months after enrollment
|
We will measure the response rate from care partners to complete the FCMAHS over the phone or electronically. The FCMAHS is a validated caregiver-reported outcome measure that assesses burden associated with medication administration. The instrument consists of 24 items and four subscales: Information Seeking/Information Sharing (9 items), Safety Issues (5 items), Scheduling Logistics (7 items) and Polypharmacy (3 items). The total score range is 0-120 with higher scores indicating greater perceived hassle associated with managing some or all aspects of another person's medication regimen. |
Baseline and 3 months after enrollment
|
Time to Complete the Family Caregiver Medication Administration Hassles Scale (FCMAHS)
Time Frame: Baseline and 3 months after enrollment
|
We will measure the time it takes the care partner to complete the FCMAHS over the phone or electronically. The FCMAHS is a validated caregiver-reported outcome measure that assesses burden associated with medication administration. The instrument consists of 24 items and four subscales: Information Seeking/Information Sharing (9 items), Safety Issues (5 items), Scheduling Logistics (7 items) and Polypharmacy (3 items). The total score range is 0-120 with higher scores indicating greater perceived hassle associated with managing some or all aspects of another person's medication regimen. |
Baseline and 3 months after enrollment
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Ariel Green, MD, MPH, PhD, Johns Hopkins University
Publications and helpful links
General Publications
- Alzheimer's Association. 2016 Alzheimer's disease facts and figures. Alzheimers Dement. 2016 Apr;12(4):459-509. doi: 10.1016/j.jalz.2016.03.001.
- Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005 Aug 10;294(6):716-24. doi: 10.1001/jama.294.6.716.
- Lin PJ, Fillit HM, Cohen JT, Neumann PJ. Potentially avoidable hospitalizations among Medicare beneficiaries with Alzheimer's disease and related disorders. Alzheimers Dement. 2013 Jan;9(1):30-8. doi: 10.1016/j.jalz.2012.11.002.
- Kelley AS, McGarry K, Gorges R, Skinner JS. The burden of health care costs for patients with dementia in the last 5 years of life. Ann Intern Med. 2015 Nov 17;163(10):729-36. doi: 10.7326/M15-0381. Epub 2015 Oct 27.
- Willson MN, Greer CL, Weeks DL. Medication regimen complexity and hospital readmission for an adverse drug event. Ann Pharmacother. 2014 Jan;48(1):26-32. doi: 10.1177/1060028013510898. Epub 2013 Nov 5.
- Bayliss EA, Shetterly SM, Drace ML, Norton J, Green AR, Reeve E, Weffald LA, Wright L, Maciejewski ML, Sheehan OC, Wolff JL, Gleason KS, Kraus C, Maiyani M, Du Vall M, Boyd CM. The OPTIMIZE patient- and family-centered, primary care-based deprescribing intervention for older adults with dementia or mild cognitive impairment and multiple chronic conditions: study protocol for a pragmatic cluster randomized controlled trial. Trials. 2020 Jun 18;21(1):542. doi: 10.1186/s13063-020-04482-0.
- George J, Phun YT, Bailey MJ, Kong DC, Stewart K. Development and validation of the medication regimen complexity index. Ann Pharmacother. 2004 Sep;38(9):1369-76. doi: 10.1345/aph.1D479. Epub 2004 Jul 20.
- Travis SS, Bernard MA, McAuley WJ, Thornton M, Kole T. Development of the family caregiver medication administration hassles scale. Gerontologist. 2003 Jun;43(3):360-8. doi: 10.1093/geront/43.3.360.
- Group Health Research Institute. The Chronic Care Model. Available at http://www.improvingchroniccare.org/index.php?p=CCM_Gallery&s=149. Accessed August 21, 2020
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- IRB00286353
- 5U54AG063546-02 (U.S. NIH Grant/Contract)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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