- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06110156
Population Health Approach to Optimizing Medications in Older Adults (POP-MED)
November 16, 2023 updated by: Michelle Keller, Cedars-Sinai Medical Center
Population Health Approach to Optimizing and Deprescribing Medications in Older Adults
This randomized controlled pragmatic pilot study is aimed at examining the feasibility and acceptability of a population health-based deprescribing intervention that leverages the a registry and polypharmacy risk prediction model.
It includes four arms (2 intervention and 2 control arms) and uses a parallel arm study design.
Study Overview
Status
Not yet recruiting
Conditions
Intervention / Treatment
Detailed Description
This pilot clinical trial is aimed at examining the feasibility and acceptability of a medication management intervention that uses risk stratification to identify older adults (including older adults with Mild Cognitive Impairment or Alzheimer's Disease and Related Dementias) at greatest risk for polypharmacy-related adverse events.
The intervention will use a risk prediction model to identify potential study participants for inclusion and will enroll these study participants and their care partners into a polypharmacy clinic.
The study will stratify patients by cognitive impairment status.
The risk prediction model includes variables such as: age, sex, recent healthcare encounters, current and past medications, current and past lab tests, current and past diagnoses.
Study Type
Interventional
Enrollment (Estimated)
100
Phase
- Not Applicable
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
- Older Adult
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Patients will be invited to enroll in the study if they are in the top quintile of risk selected by a risk prediction model of polypharmacy-related adverse events. The risk prediction model includes variables such as: age, sex, recent healthcare encounters, current and past medications, current and past lab tests, current and past diagnoses.
- 65 years of age or older
- Have a primary care clinician within the Cedars-Sinai Health System who uses MyCSLink (electronic health record used by Cedars-Sinai).
- Part of a Cedars-Sinai Health System population health registry (e.g., enrolled in an Accountable Care Organization, Medicare Advantage plan, or Primary Care First program)
- Diagnosis of Mild Cognitive Impairment or Dementia at baseline (for one intervention group) on the problem list
Exclusion criteria include:
- Patients for whom there is an active substance use disorder (defined by a physician) and thus for whom the intervention may not be appropriate
- Patients with an organ transplant, who are typically followed by a specialty pharmacist
- Visits with a Cedars-Sinai Medical Center pharmacist for a polypharmacy consult within the last 12 months
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: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Patient-tailored deprescribing assessment and intervention (MCI and Dementia diagnosis)
Patients are identified for enrollment via a risk prediction model and enrolled in a pharmacist-led polypharmacy clinic.
The pharmacist will conduct a comprehensive medication review, which will include: medication reconciliation, assessment of patient risk factors, identification of potentially inappropriate medications, identification of potential prescribing omissions, shared decision-making with the patient and/or caregiver, and confirmation of the results with the primary care clinician (PCP).
Once the PCP has approved the recommendations, the pharmacist will make the appropriate changes to the medication regimen, will provide tailored medication education and counseling and will follow-up with the patient at least once per month to assess side effects, adverse effects, and provide support.
This arm specifically includes only patients with a diagnosis of Mild Cognitive Impairment (MCI) or Alzheimer's Disease and Related Dementias (ADRD) at enrollment.
|
Patients are identified for enrollment via a risk prediction model and enrolled in a pharmacist-led polypharmacy clinic.
The pharmacist will conduct a comprehensive medication review, which will include: medication reconciliation, assessment of patient risk factors (clinical, socioeconomic), identification of potentially inappropriate medications, identification of potential prescribing omissions, shared decision-making with the patient and/or caregiver, and confirmation of the results of the comprehensive medication review with the primary care clinician.
Once the primary care clinician has approved the recommendations, the pharmacist will make the appropriate changes to the medication regimen, will provide tailored medication education and counseling (including Motivational Interviewing) and will follow-up with the patient at least once per month via video visit or phone to assess side effects, adverse effects, and provide support.
|
No Intervention: Usual care (MCI and Dementia diagnosis)
Patients in the comparator arm will see their primary care clinician as needed.
This arm specifically includes patients with a diagnoses of Mild Cognitive Impairment (MCI) or Alzheimer's Disease and Related Dementias (ADRD) at enrollment.
|
|
Experimental: Patient-tailored deprescribing assessment and intervention (no MCI and Dementia diagnosis)
Patients are identified for enrollment via a risk prediction model and enrolled in a pharmacist-led polypharmacy clinic.
The pharmacist will conduct a comprehensive medication review, which will include: medication reconciliation, assessment of patient risk factors, identification of potentially inappropriate medications, identification of potential prescribing omissions, shared decision-making with the patient and/or caregiver, and confirmation of the results with the primary care clinician (PCP).
Once the PCP has approved the recommendations, the pharmacist will make the appropriate changes to the medication regimen, will provide tailored medication education and counseling and will follow-up with the patient at least once per month to assess side effects, adverse effects, and provide support.
This arm specifically includes only patients with NO diagnosis of Mild Cognitive Impairment (MCI) or Alzheimer's Disease and Related Dementias (ADRD) at enrollment.
|
Patients are identified for enrollment via a risk prediction model and enrolled in a pharmacist-led polypharmacy clinic.
The pharmacist will conduct a comprehensive medication review, which will include: medication reconciliation, assessment of patient risk factors (clinical, socioeconomic), identification of potentially inappropriate medications, identification of potential prescribing omissions, shared decision-making with the patient and/or caregiver, and confirmation of the results of the comprehensive medication review with the primary care clinician.
Once the primary care clinician has approved the recommendations, the pharmacist will make the appropriate changes to the medication regimen, will provide tailored medication education and counseling (including Motivational Interviewing) and will follow-up with the patient at least once per month via video visit or phone to assess side effects, adverse effects, and provide support.
|
No Intervention: Usual care (no MCI and Dementia diagnosis)
Patients in the comparator arm will see their primary care clinician as needed.
This arm specifically includes patients with NO diagnoses of Mild Cognitive Impairment (MCI) or Alzheimer's Disease and Related Dementias (ADRD) at enrollment.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Composite measure of healthcare utilization
Time Frame: 12 months after enrollment
|
We will sum up the number of same-hospital all-cause emergency department (ED) and inpatient visits for each study participant in all arms at 12 months.
|
12 months after enrollment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Total number of medications
Time Frame: Baseline, 12 months
|
Total number of medications on the medication list, including prescription medications, over-the-counter medications, vitamins, and supplements at 12 months.
|
Baseline, 12 months
|
Use of any potentially inappropriate medications
Time Frame: Baseline, 12 months
|
Use of any potentially inappropriate medications, defined by the 2022 Beers Criteria Tables 2 and 7
|
Baseline, 12 months
|
Total number of potentially inappropriate medications
Time Frame: Baseline, 12 months
|
Total number of of potentially inappropriate medications at baseline and 12 months using Beers Tables 2 and 7
|
Baseline, 12 months
|
Number of medications with a dose reduction >10% over 12 months
Time Frame: 12 months
|
We will sum up the number of medications where the study participant has achieved at >10% dose reduction compared to baseline for each study participant at baseline and 12 months in both study arms.
|
12 months
|
Number of re-prescription of any medications over 12 months
Time Frame: Baseline, 12 months
|
We will sum up the number of medications where the study participant has had any re-prescription of medications which were discontinued for 90 days or more by 12 months in all study arms.
|
Baseline, 12 months
|
Medication regimen simplification, measured by counting the number of times per day medications are taken, at baseline and 12 months
Time Frame: Baseline, 12 months
|
Each study participant will be coded on a continuous scale the number of times a day medications are taken based on the prescription instructions at baseline and 12 months in all study arms.
|
Baseline, 12 months
|
Medicare adherence
Time Frame: Baseline, 12 months
|
Each study participant will be coded on a continuous scale extracted by comparing EHR prescriptions and pharmacy claims fills at baseline and 12 months in all study arms.
|
Baseline, 12 months
|
Change in risk prediction model score
Time Frame: 12 months
|
Each study participant's information will be run through the risk prediction model at the end of the study to see if there is a meaningful change (10% or more change) in the risk prediction score from baseline to the end of the study period.
|
12 months
|
Number of drug-related problems
Time Frame: Baseline, 12 months
|
We will compare the total number of drug-related problems (identified retrospectively by a pharmacist) at baseline and 12 months.
|
Baseline, 12 months
|
Number of potential pharmacy recommendations
Time Frame: Baseline, 12 months
|
We will compare the total number of potential pharmacist recommendations (identified retrospectively by a pharmacist) at baseline and 12 months.
|
Baseline, 12 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
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 (Estimated)
December 1, 2023
Primary Completion (Estimated)
June 1, 2025
Study Completion (Estimated)
June 1, 2025
Study Registration Dates
First Submitted
October 26, 2023
First Submitted That Met QC Criteria
October 26, 2023
First Posted (Actual)
October 31, 2023
Study Record Updates
Last Update Posted (Estimated)
November 17, 2023
Last Update Submitted That Met QC Criteria
November 16, 2023
Last Verified
November 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- STUDY00002921
- K01AG076865 (U.S. NIH Grant/Contract)
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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