Appropriate Polypharmacy in Older People in Primary Care
NCT ID: NCT04181879
Last Updated: 2021-12-02
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
68 participants
INTERVENTIONAL
2019-09-01
2021-12-31
Brief Summary
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Detailed Description
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Design: Pilot cluster randomized controlled trial
Unit of randomization: GP practice.
Unit of analysis: Patient and GP practice.
Setting: Practices located in Northern Ireland will be recruited via Research Nurse(s) from the Northern Ireland Clinical Research Network (NICRN - Primary Care). In the Republic of Ireland a Research Nurse(s) from Trinity College Dublin will recruit GP practices located in the border counties of Cavan, Donegal, Leitrim, Louth, Monaghan and Sligo.
Study aim: The overall aim of the study is to undertake a pilot cluster randomised controlled trial (cRCT) of a theory-based intervention targeting prescribing of appropriate polypharmacy in primary care (PolyPrime) to assess the feasibility of a definitive cRCT of the PolyPrime intervention.
The main study objectives are:
* To test approaches to sampling, recruitment and retention of GP practices
* To test approaches to screening, recruitment and retention of patients
* To test the feasibility of using medication appropriateness (assessed using the STOPP/START criteria) as the primary outcome in a future cRCT
* To identify the intervention's likely mechanism of action
* To assess if the intervention was delivered and received as intended (intervention fidelity)
* To identify the resources used in the set-up and delivery of the intervention and their associated costs
* To assess the feasibility of a future cost-effectiveness analysis
* To further validate the Medication-Related Burden quality of life (MRQ-QoL) tool
* To obtain estimates of effect size between groups, cluster size and intraclass correlation coefficients (ICCs) to inform the sample size calculation for a full RCT
Recruitment strategy for patients: Each recruited general practice will be asked to recruit 10 older patients meeting the inclusion criteria (i.e. over 70 years old, receiving four or more regular medicines, not cognitively impaired, not have a terminal illness, resident in the community, be in receipt of a valid general medical services (GMS) card in the Republic of Ireland, or for Northern Ireland patients, registered for NHS primary care services and registered with and/or regularly attending the practice for a minimum of 12 months). Each recruited GP practice will also display a patient recruitment poster in their practice waiting areas. Posters will direct patients to ask at reception if they are interested in taking part in the study.
The GP Practice Manager (or equivalent) will screen patient records facilitated and supported by the research nurses. Each practice will identify and filter potentially eligible participants via patient records. This will be done in batches depending upon the size of the practice list. Patients will be screened on the basis of the inclusion/exclusion criteria as specified in the protocol. A screening log will be provided to practices to record screening and recruitment activity, including the reason(s) for not being enrolled on the study. The screening log will be kept securely at the practice and no identifying data will leave the practice.
Intervention delivery: The intervention (video) will be delivered to recruited GPs allocated to the intervention arm using the 'Riverside' software programme. This software programme allows electronic, multimedia material to be delivered to healthcare professionals and students. GPs will be provided with a single generic username and password that will allow them to access the video on a secure online server. Prior to the commencement of the study, all participating GPs will be provided with instructions from the researcher on how to access the video. The researcher will be fully contactable during the study to answer any questions or queries that participating GPs may have about accessing the video.
Once consented, patients recruited by the GP practices allocated to the intervention arm will be asked to attend two appointments (telephone or online consultations where a face-to-face consultation is not possible) at a time convenient to them to have their medicines reviewed by a GP in addition to their usual care. Patients recruited by the GP practices allocated to the control arm will continue to receive usual care.
Data will be collected from recruited GPs, recruited patients and practice records. Recruited patients will be asked to complete a number of questionnaires relating to their general well-being and use of the health service (e.g. hospital admissions) at baseline, six months and nine months post-initial medication review in the intervention arm and the equivalent time points in the control arm. The follow up time points for the control arm will be based on the average length of time from the completion of baseline data collection to six and nine months post initial medication review in the intervention arm. Patient data (including medical history, clinical conditions, biochemical data (i.e. test results) and prescribed medications) will also be collected from GP records at baseline, six months and nine months by a Research Nurse from the Northern Ireland Clinical Research Network (NICRN Primary Care) or Trinity College Dublin (TCD).
At the end of the intervention, interviews will be conducted with up to 10 GPs and six members of practice staff (i.e. those involved in implementing the intervention within each practice) respectively in the six intervention arm practices. GPs will be asked about their views on the support provided by the research team; the intervention package (and supporting materials); study procedures (e.g. screening, recruitment, etc.), while practice staff will be asked about their views on the study procedures (e.g. screening, recruitment, etc.) and acceptability of the intervention. Patients from the six intervention group practices will be asked to complete a feedback questionnaire after the delivery of the intervention (i.e. after completion of their final follow-up questionnaires). Patients will be asked about their views on the study procedures (e.g. completing questionnaires, recruitment etc.) and acceptability of the intervention.
Who is funding the study: HSC R\&D Division Cross-border Healthcare Intervention Trials in Ireland Network (CHITIN), UK and Ireland
Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
HEALTH_SERVICES_RESEARCH
SINGLE
Due to the nature of the intervention package (i.e. access to the video and patient recall), we will be unable to blind the GPs or patients.
Study Groups
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Intervention
GPs will receive the intervention package and conduct medication reviews with recruited patients
Intervention
* GPs allocated to the intervention will be given access to the intervention package and asked to perform medication reviews with approximately 10 patients on two occasions (initial and 6-months follow-up).
* The intervention package consists of two components: (a) an online video demonstrating how GPs can improve appropriate polypharmacy during typical consultations with older patients; (b) a patient recall process (appointment with the GP for a medication review).
* GPs will be asked to schedule appointments with consenting patients (telephone or online consultations where a face-to-face consultation is not possible). During these appointments, GPs will undertake medication reviews ('a structured, critical examination of a person's medicines with the objective of reaching an agreement with the person about treatment, optimising the impact of medicines, minimising the number of medication-related problems and reducing waste').
Usual care
GPs will continue to treat recruited patients as usual
No interventions assigned to this group
Interventions
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Intervention
* GPs allocated to the intervention will be given access to the intervention package and asked to perform medication reviews with approximately 10 patients on two occasions (initial and 6-months follow-up).
* The intervention package consists of two components: (a) an online video demonstrating how GPs can improve appropriate polypharmacy during typical consultations with older patients; (b) a patient recall process (appointment with the GP for a medication review).
* GPs will be asked to schedule appointments with consenting patients (telephone or online consultations where a face-to-face consultation is not possible). During these appointments, GPs will undertake medication reviews ('a structured, critical examination of a person's medicines with the objective of reaching an agreement with the person about treatment, optimising the impact of medicines, minimising the number of medication-related problems and reducing waste').
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Patients must be receiving four or more regular medicines
* Patients must be resident in the community
* Patients must be in receipt of a valid general medical services (GMS) card in the Republic of Ireland, or in the case of Northern Ireland patients, registered for NHS primary care services
* Patients must be registered with and/or regularly attending the practice for a minimum of 12 months
Exclusion Criteria
* Patients who are cognitively impaired
* Patients with a terminal illness
* Involved in other Investigational Medicinal Product (IMP) or medicines management studies
70 Years
ALL
Yes
Sponsors
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University of Dublin, Trinity College
OTHER
Royal College of Surgeons, Ireland
OTHER
National University of Ireland, Galway, Ireland
OTHER
Belfast Health and Social Care Trust
OTHER
Queen's University, Belfast
OTHER
Responsible Party
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Carmel Hughes
Professor
Principal Investigators
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Carmel Hughes, PhD
Role: PRINCIPAL_INVESTIGATOR
Queen's University, Belfast
Locations
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Trinity College Dublin
Dublin, , Ireland
Queen's University Belfast
Belfast, Antrim, United Kingdom
Countries
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References
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Cadogan CA, Ryan C, Gormley GJ, Francis JJ, Passmore P, Kerse N, Hughes CM. A feasibility study of a theory-based intervention to improve appropriate polypharmacy for older people in primary care. Pilot Feasibility Stud. 2017 Jul 20;4:23. doi: 10.1186/s40814-017-0166-3. eCollection 2018.
Cadogan CA, Ryan C, Francis JJ, Gormley GJ, Passmore P, Kerse N, Hughes CM. Development of an intervention to improve appropriate polypharmacy in older people in primary care using a theory-based method. BMC Health Serv Res. 2016 Nov 16;16(1):661. doi: 10.1186/s12913-016-1907-3.
Rankin A, Cadogan CA, Barry HE, Gardner E, Agus A, Molloy GJ, Gorman A, Ryan C, Leathem C, Maxwell M, Gormley GJ, Ferrett A, McCarthy P, Fahey T, Hughes CM; PolyPrime team. An external pilot cluster randomised controlled trial of a theory-based intervention to improve appropriate polypharmacy in older people in primary care (PolyPrime): study protocol. Pilot Feasibility Stud. 2021 Mar 19;7(1):77. doi: 10.1186/s40814-021-00822-2.
Rankin A, Molloy GJ, Cadogan CA, Barry HE, Gorman A, Ryan C, Ferrett A, McCarthy P, Gormley GJ, Fahey T, Hughes CM; PolyPrime team. Protocol for a process evaluation of an external pilot cluster randomised controlled trial of a theory-based intervention to improve appropriate polypharmacy in older people in primary care: the PolyPrime study. Trials. 2021 Jul 14;22(1):449. doi: 10.1186/s13063-021-05410-6.
Rankin A, Gorman A, Cole J, Cadogan CA, Barry HE, Agus A, Logan D, McDowell C, Molloy GJ, Ryan C, Leathem C, Maxwell M, Brennan C, Gormley GJ, Ferrett A, McCarthy P, Fahey T, Hughes CM; PolyPrime team. An external pilot cluster randomised controlled trial of a theory-based intervention to improve appropriate polypharmacy in older people in primary care (PolyPrime). Pilot Feasibility Stud. 2022 Sep 10;8(1):203. doi: 10.1186/s40814-022-01161-6.
Other Identifiers
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B19/20
Identifier Type: -
Identifier Source: org_study_id