A patient-centered deprescribing intervention for hospitalized older patients with polypharmacy: rationale and design of the Shed-MEDS randomized controlled trial

Eduard E Vasilevskis, Avantika S Shah, Emily K Hollingsworth, Matthew S Shotwell, Amanda S Mixon, Susan P Bell, Sunil Kripalani, John F Schnelle, Sandra F Simmons, Shed-MEDS Team, Carole Bartoo, Jennifer Kim, Kanah Lewallen, Whitney Narramore, Robin Parker, Susan Lincoln, Joanna Gupta, Eduard E Vasilevskis, Avantika S Shah, Emily K Hollingsworth, Matthew S Shotwell, Amanda S Mixon, Susan P Bell, Sunil Kripalani, John F Schnelle, Sandra F Simmons, Shed-MEDS Team, Carole Bartoo, Jennifer Kim, Kanah Lewallen, Whitney Narramore, Robin Parker, Susan Lincoln, Joanna Gupta

Abstract

Background: Polypharmacy is prevalent among hospitalized older adults, particularly those being discharged to a post-care care facility (PAC). The aim of this randomized controlled trial is to determine if a patient-centered deprescribing intervention initiated in the hospital and continued in the PAC setting reduces the total number of medications among older patients.

Methods: The Shed-MEDS study is a 5-year, randomized controlled clinical intervention trial comparing a patient-centered describing intervention with usual care among older (≥50 years) hospitalized patients discharged to PAC, either a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IPR). Patient measurements occur at hospital enrollment, hospital discharge, within 7 days of PAC discharge, and at 60 and 90 days following PAC discharge. Patients are randomized in a permuted block fashion, with block sizes of two to four. The overall effectiveness of the intervention will be evaluated using total medication count as the primary outcome measure. We estimate that 576 patients will enroll in the study. Following attrition due to death or loss to follow-up, 420 patients will contribute measurements at 90 days, which provides 90% power to detect a 30% versus 25% reduction in total medications with an alpha error of 0.05. Secondary outcomes include the number of medications associated with geriatric syndromes, drug burden index, medication adherence, the prevalence and severity of geriatric syndromes and functional health status.

Discussion: The Shed-MEDS trial aims to test the hypothesis that a patient-centered deprescribing intervention initiated in the hospital and continuing through the PAC stay will reduce the total number of medications 90 days following PAC discharge and result in improvements in geriatric syndromes and functional health status. The results of this trial will quantify the health outcomes associated with reducing medications for hospitalized older adults with polypharmacy who are discharged to post-acute care facilities.

Trial registration: This trial was prospectively registered at clinicaltrials.gov ( NCT02979353 ). The trial was first registered on 12/1/2016, with an update on 09/28/17 and 10/12/2018.

Keywords: Adverse drug events; Deprescribing; Geriatric syndromes; Geriatrics; Medications; Polypharmacy.

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was granted by the Vanderbilt University Medical Center Institutional Review Board IRB#161571. Written Informed consent is obtained from each patient (or their respective surrogate) in the Shed-MEDS trial.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow of Participants through Study
Fig. 2
Fig. 2
Conceptual Framework for Deprescribing Intervention (Shed-MEDS)

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