Efficacy and Feasibility of De-prescribing Rounds in a Singapore Rehabilitative Hospital- a Pilot Randomized Controlled Trial
NCT ID: NCT03713112
Last Updated: 2020-05-20
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
NA
260 participants
INTERVENTIONAL
2018-11-28
2020-06-30
Brief Summary
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Detailed Description
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AIM: This study aims to evaluating the effects of a weekly multidisciplinary team(MDT) de-prescribing round on the reduction on total daily dose, cost of medications, its safety and feasibility in a Singapore rehabilitative hospital.
Methods: A total of 260 newly admitted patients will be randomised to a de-prescribing intervention (n= 130) or control (usual care) group (n= 130), using GraphPad randomization sequence software ©2017. The 5 steps of deprescribing process will be used and the targets of deprescribing are Beer's list of potentially inappropriate medications (AGS 2015 version), predetermined supplements and symptomatic medications. Predetermined medications were deprescribed following initial MDT assessment, discussion with attending doctors and consideration of patients' preferences regarding discontinuation or dose reduction. Total daily dose reduction, cost and side effects of deprescribing were monitored on admission day 14, 28, discharge day and post-discharge day 28. Time required for such rounds are also measured.
IMPACT: Once proven successful, this effective model of deprescribing could safely help to cut down caregiver's medicine administrative burden, improve compliance and reduce national healthcare cost. This model could also be easily replicated in all Singapore rehabilitative hospitals.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
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Weekly MDT deprescribing rounds
Weekly MDT deprescribing rounds for certain drugs will be performed on top of usual care.
Weekly MDT deprescribing rounds for certain drugs
* Weekly deprescribing round (from randomization to day of discharge)
* Conducted by a multidisciplinary team (non-ward doctors, pharmacist, ward nurse)
* Using the 5 steps of de-prescribing
* De-prescribing targets:
1. Beer's list of potentially inappropriate medications (American Geriatric Society 2015 version)
2. Supplements of questionable benefits (glucosamine, chondroitin, vitamin B complex and multivitamins)
3. Symptomatic medications (laxatives, gastro-protectives, painkillers, anti-emetics and steroid creams) (Standardized verbal script to initiate de-prescribing by the team)
* On top of usual care
Control (Usual Care)
Usual Care includes the following:
* De-prescribing at the discretion of the ward doctors
* Initial medication reconciliation by pharmacist on admission
* Ward rounds to be conducted 3 weekdays per week for rehabilitative patients and daily on weekdays for sub-acute patients.
No interventions assigned to this group
Interventions
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Weekly MDT deprescribing rounds for certain drugs
* Weekly deprescribing round (from randomization to day of discharge)
* Conducted by a multidisciplinary team (non-ward doctors, pharmacist, ward nurse)
* Using the 5 steps of de-prescribing
* De-prescribing targets:
1. Beer's list of potentially inappropriate medications (American Geriatric Society 2015 version)
2. Supplements of questionable benefits (glucosamine, chondroitin, vitamin B complex and multivitamins)
3. Symptomatic medications (laxatives, gastro-protectives, painkillers, anti-emetics and steroid creams) (Standardized verbal script to initiate de-prescribing by the team)
* On top of usual care
Eligibility Criteria
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Inclusion Criteria
* Newly admitted to rehabilitation or sub-acute disciplines
* Possess 1 or more of the targeted medications
Exclusion Criteria
* No mental capacity
65 Years
120 Years
ALL
Yes
Sponsors
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Bright Vision Hospital
OTHER
Responsible Party
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Principal Investigators
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Wong Peng Yong, Andrew, MBBS
Role: PRINCIPAL_INVESTIGATOR
Bright Vision Hospital; Singhealth Community Hospitals
Locations
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Bright Vision Hospital
Singapore, , Singapore
Countries
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References
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Roberts MS, Stokes JA, King MA, Lynne TA, Purdie DM, Glasziou PP, Wilson DA, McCarthy ST, Brooks GE, de Looze FJ, Del Mar CB. Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. Br J Clin Pharmacol. 2001 Mar;51(3):257-65. doi: 10.1046/j.1365-2125.2001.00347.x.
Kutner JS, Blatchford PJ, Taylor DH Jr, Ritchie CS, Bull JH, Fairclough DL, Hanson LC, LeBlanc TW, Samsa GP, Wolf S, Aziz NM, Currow DC, Ferrell B, Wagner-Johnston N, Zafar SY, Cleary JF, Dev S, Goode PS, Kamal AH, Kassner C, Kvale EA, McCallum JG, Ogunseitan AB, Pantilat SZ, Portenoy RK, Prince-Paul M, Sloan JA, Swetz KM, Von Gunten CF, Abernethy AP. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015 May;175(5):691-700. doi: 10.1001/jamainternmed.2015.0289.
Williams ME, Pulliam CC, Hunter R, Johnson TM, Owens JE, Kincaid J, Porter C, Koch G. The short-term effect of interdisciplinary medication review on function and cost in ambulatory elderly people. J Am Geriatr Soc. 2004 Jan;52(1):93-8. doi: 10.1111/j.1532-5415.2004.52016.x.
Reeve E, Andrews JM, Wiese MD, Hendrix I, Roberts MS, Shakib S. Feasibility of a patient-centered deprescribing process to reduce inappropriate use of proton pump inhibitors. Ann Pharmacother. 2015 Jan;49(1):29-38. doi: 10.1177/1060028014558290. Epub 2014 Nov 10.
Frank C, Weir E. Deprescribing for older patients. CMAJ. 2014 Dec 9;186(18):1369-76. doi: 10.1503/cmaj.131873. Epub 2014 Sep 2. No abstract available.
Wong APY, Ting TW, Charissa EJM, Boon TW, Heng KY, Leng LL. Feasibility & Efficacy of Deprescribing rounds in a Singapore rehabilitative hospital- a randomised controlled trial. BMC Geriatr. 2021 Oct 21;21(1):584. doi: 10.1186/s12877-021-02507-0.
Related Links
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Ee et al, Effectiveness and feasibility of deprescribing of symptomatic medications in a Singapore rehabilitation hospital; DOI: 10.1177/2010105818782006 journals.sagepub.com/home/psh
Other Identifiers
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CIRB Ref 2018/2721
Identifier Type: -
Identifier Source: org_study_id
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