Effects of an interprofessional Quality Circle-Deprescribing Module (QC-DeMo) in Swiss nursing homes: a randomised controlled trial

Damien Cateau, Pierluigi Ballabeni, Anne Niquille, Damien Cateau, Pierluigi Ballabeni, Anne Niquille

Abstract

Background: Potentially inappropriate medications (PIMs) are common among nursing homes (NH) residents, as is polypharmacy. Deprescribing has emerged in the past decade as a safe and effective way to reduce the use of PIMs and improve patient outcomes. However, effective deprescribing interventions are expensive, as they require specialised staff and a great amount of time for each resident. The Quality Circle Deprescribing Module (QC-DeMo) intervention was designed to be less resource-intensive than medication reviews, the current deprescribing gold standard. It consists of a QC session in which physicians, nurses, and pharmacists define a local deprescribing consensus for specific PIMs classes, which is then implemented in the NH. The intervention was trialled in a RCT, with the NH as unit of analysis.

Methods: After randomisation, intervention NHs enacted the QC-DeMo at the start of the follow-up year. The primary outcomes were the proportion of PIM galenic units and number of PIM defined daily dose per average resident and per day (DDD/res). PIM status was assessed by a combination of the 2015 Beers list and the Norwegian General Practice-Nursing Home criteria. Secondary outcomes were the number of DDD/res to avoid and to reevaluate; safety outcomes were mortality, hospitalisations, falls, and use of physical restraints. Outcomes were evaluated at follow-up using linear regression models, adjusting for the outcome baseline values.

Results: Fifty-eight NHs took part in the trial; no individual residents were recruited. The intervention did not reduce the primary outcomes, but a strong trend towards reduction was seen for the number of PIM DDD/res, which accounts for the doses used. PIM DDD/res to reevaluate were significantly reduced, mostly through a reduction in the use of proton-pump inhibitors. Falls and use of physical restraints were not affected, but a statistical interaction between the mission of the NH (geriatric unit or specialised dementia unit) and the intervention group was seen for mortality and hospitalisations.

Conclusions: The QC-DeMo intervention can reduce the use of some PIM classes, and could usefully complement other deprescribing interventions.

Trial registration: ClinicalTrials.gov ( NCT03688542 ), registered on 26.09.2018, retrospectively registered.

Keywords: Collaboration; Deprescribing; Nursing home; Potentially inappropriate medications; Quality circle.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Process of the QC-DeMo intervention; QC-DeMo: Quality Circle Deprescribing Module; NH: nursing home; QC: quality circle
Fig. 2
Fig. 2
Flow-chart for the QC-DeMo trial. GP: general practitioner; NH: nursing home. Round 1 joined in 2017, round 2 in 2018

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