A Multidisciplinary Intervention Including a Clinical Decision Support System and an App for Drug Therapy Management in Older Patients

NCT ID: NCT04391218

Last Updated: 2021-03-05

Study Results

Results pending

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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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

89 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-05-31

Study Completion Date

2021-05-31

Brief Summary

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"La Casa nel Parco" (CANP) Project is a European Union and Regione Piemonte funded multidisciplinary project aimed to explore innovative technology application in older subject care. In this context, FARMA-CANP is a randomized open-label clinical trial evaluating a multidisciplinary intervention in older patients hospitalized at home. The intervention involves physicians, pharmacists, nurses and includes a Clinical Decision Support System to help the processes of therapeutic review and reconciliation, and an end-user App to support patients and/or caregivers in the daily management of drug therapy.

The main objectives of the study are to evaluate the impact of the intervention on 1) medication adherence after discharge 2) medication appropriateness.

Detailed Description

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Conditions

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Polypharmacy Multimorbidity Aged

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Multidisciplinary Approach Group

Multidisciplinary medication review and reconciliation during hospitalization involving geriatricians, nurses, pharmacists and supported by a Clinical Decision Support System, followed by an end-user App to support patients/caregivers in the correct drug intake after discharge.

Group Type EXPERIMENTAL

Multidisciplinary Approach Group

Intervention Type OTHER

Geriatricians will introduce medication review data on a Clinical Decision Support System, that will help both pharmacists and physicians in medication reconciliation, highligting potentially inappropriate prescriptions according to Beers' criteria and STOPP/START criteria, and potential controindicated and major Drug-Drug Interactions according to Micromedex. Before Hospital at Home discharge, nurses will instruct patients and/or caregivers to the use of an App, where daily drug therapy at discharge will be inserted and scheduled. This App will automatically create an alert everytime a drug dose needs to be taken, alongside an image of the specific drug packaging. The App will register if and when the patient actually takes the drug, or the reason for the delayed/missed dose.

Control Group

Medication review and reconciliation will be performed by geriatricians according to Good Clinical Practice and usual habits, that might also include digital and printed supports for medication appropriateness and drug interaction. Drug therapy will be listed and explained to the patient/caregiver at discharge. Patients/caregivers will be allowed to use any tools to support medication adherence, according to their habits and preferences (i.e. calendars, alarms, pill boxes).

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Multidisciplinary Approach Group

Geriatricians will introduce medication review data on a Clinical Decision Support System, that will help both pharmacists and physicians in medication reconciliation, highligting potentially inappropriate prescriptions according to Beers' criteria and STOPP/START criteria, and potential controindicated and major Drug-Drug Interactions according to Micromedex. Before Hospital at Home discharge, nurses will instruct patients and/or caregivers to the use of an App, where daily drug therapy at discharge will be inserted and scheduled. This App will automatically create an alert everytime a drug dose needs to be taken, alongside an image of the specific drug packaging. The App will register if and when the patient actually takes the drug, or the reason for the delayed/missed dose.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patient age ≥ 65 years
* Hospital at Home admission
* Presence of a caregiver
* Written informed consent signed by both the patient and the caregiver

Exclusion Criteria

* Unavailable internet access and/or portable device to install the App on
* Severe cognitive impairment with behavioural symptoms
* Estimated life expectancy less than 3 months
* Death during Hospital at Home stay
* Hospital at Home discharge to an other healthcare facility (i.e. Emergency Department, Nursing Home)
* No regular medications precribed at Hospital at Home discharge.
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Turin, Italy

OTHER

Sponsor Role collaborator

Infologic S.r.l., Padova, Italy

UNKNOWN

Sponsor Role collaborator

Consoft Sistemi S.p.A. Turin, Italy

UNKNOWN

Sponsor Role collaborator

ASL Città di Torino, Italy

UNKNOWN

Sponsor Role collaborator

A.O.U. Città della Salute e della Scienza

OTHER

Sponsor Role lead

Responsible Party

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Dott.ssa RENATA MARINELLO

Dirigente Medico, S.C. Geriatria e Malattie Metaboliche dell'Osso U, Ospedalizzazione a Domicilio

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Renata Marinello, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy

Central Contacts

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Renata Marinello, MD, PhD

Role: CONTACT

0116334771 ext. +39

References

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O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015 Mar;44(2):213-8. doi: 10.1093/ageing/afu145. Epub 2014 Oct 16.

Reference Type BACKGROUND
PMID: 25324330 (View on PubMed)

By the 2019 American Geriatrics Society Beers Criteria(R) Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria(R) for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019 Apr;67(4):674-694. doi: 10.1111/jgs.15767. Epub 2019 Jan 29.

Reference Type BACKGROUND
PMID: 30693946 (View on PubMed)

Related Links

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https://www.micromedexsolutions.com

Micromedex® online database. International Business Machines Corporation (IBM) Watson Health, Greenwood Village, Colorado, USA.

Other Identifiers

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FARMA-CANP

Identifier Type: -

Identifier Source: org_study_id

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