Effects of an interprofessional deprescribing intervention in Swiss nursing homes: the Individual Deprescribing Intervention (IDeI) randomised controlled trial

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

Abstract

Background: Deprescribing polypharmacy and potentially inappropriate medications (PIMs) has been shown to be beneficial to nursing home (NH) residents' health. Medication reviews are the most widely studied deprescribing intervention; in a previous trial, we showed that another intervention, a deprescribing-focused interprofessional quality circle, can reduce the use of inappropriate medications at the NH level. However, this intervention cannot account for the variety of the residents' clinical situations. Therefore, we trialled a subsequent intervention in NH that enacted the quality circle intervention in the previous year.

Methods: In 7 NHs, the most heavily medicated residents were recruited and randomised to receive usual care or the intervention. The intervention was a pharmacist-led, deprescribing-focused medication review, followed by the creation of an individualised treatment modification plan in collaboration with nurses and physicians. Intervention's effects were assessed after four months on the number and dose of PIMs used, quality of life, and safety outcomes (mortality, hospitalisations, falls, and use of physical restraints). Data were analysed using Poisson multivariate regression models.

Results: Sixty-two NH residents participated, falling short of the expected 100 participants; 4 died before initial data collection. Participants used a very high number of drugs (median 15, inter-quartile range [12-19]) and PIMs (median 5, IQR [3-7]) at baseline. The intervention did not reduce the number of PIMs prescribed to the participants; however, it significantly decreased their dose (incidence rate ratio 0.763, CI95 [0.594; 0.979]), in particular for chronic drugs (IRR 0.716, CI95 [0.546; 0.938]). No adverse effects were seen on mortality, hospitalisations, falls, and restraints use, but, in the intervention group, three participants experienced adverse events that required the reintroduction of withdrawn treatments, and a decrease in quality of life is possible.

Conclusions: As it did not reach its recruitment target, this trial should be seen as exploratory. Results indicate that, following a NH-level deprescribing intervention, a resident-level intervention can further reduce some aspects of PIMs use. Great attention must be paid to residents' well-being when further developing such deprescribing interventions, as a possible reduction in quality of life was found in the intervention group, and some participants suffered adverse events following deprescribing.

Trial registration: ClinicalTrials.gov (NCT03688542, https://ichgcp.net/clinical-trials-registry/NCT03688542 ), registered on 31.08.2018.

Keywords: Collaboration; Deprescribing; Medication review; Nursing home; Potentially inappropriate medications.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow-chart for the IDeI trial. NH: nursing home; *: NHs allocated to the intervention group in the QC-DeMo trial; †: only the treatment-related outcomes could be assessed
Fig. 2
Fig. 2
effect of the intervention on the use of PIMs and chronic drugs; n = 58 unless otherwise specified; all analysis performed with Poisson regression (incidence rate ratio reported), except for EQ-5D-5L (linear regression). PIM: potentially inappropriate medication; DDD: defined daily dose; EQ-5D-5L: EuroQol-5 Dimensions-5 Levels

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