Improving Medication Prescription in the contExt of Advance Care Planning for paTients Receiving Long Term nUrSing Home Care
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 450
- 试验地点
- 14
- 主要终点
- Potential under- and overprescribing
研究概览
简要总结
Research aim:
To investigate the effect of training health care professionals in medication assessments on the medication use of nursing home residents with a limited life expectancy (< 1.5-2 years).
The core of the training is to tailor medication use to (palliative) treatment goals of nursing home residents.
Design:
A cluster randomized controlled trial on long term care wards in nursing homes, with the nursing home care organisations as unit of randomisation. The investigators intent to include 6 organisations and 450 nursing home patients. The research starts in september and lasts 1 year and 3 months. Eligible patients are nursing home patients of 65 years and older with a limited life expectancy (< 1.5-2 year) of long term care wards.
Intervention:
The intervention includes a method in which healthcare professionals (medical practitioner, pharmacist and care worker) are trained to tailor medication to the (palliative) treatment goals of nursing home patients with a limited life expectancy. The training consists of 2 components: 1) medication assessment, and 2) advance care planning (ACP). In the intervention group, healthcare professionals receive the training in combination with supporting tools and educational materials, in the control group care continues as normal. The allocation ratio for control and intervention groups is 1:1. A process evaluation will take place simultaneously with the intervention study. Data collection takes place before the start of the intervention (T0), after 6 months (T1) and after 12 months (T2).
Outcome measures:
The primary outcome measure is potential under- and over-treatment with medication. The secondary outcome measure is experienced involvement in decision-making (measured with a short questionnaire based on the revised PATD (patients' attitude towards deprescribing)). Tertiary outcome measures are: quality of life, deaths, falls, hospital admissions/acute first aid referrals and pain.
Discussion:
The intervention is expected to result in a decrease in chronic and preventive medication prescriptions, an increase in medication for symptom treatment and more involvement (and satisfaction) of the nursing home resident in decision-making, without adverse effects.
详细描述
Additional information on the method:
We included 2 nursinghome organizations in september, 2 in october, and 3 in november.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- None
盲法说明
Not possible due to the type of intervention
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Nursing home patients:
- •Age 65years and above
- •Living at long term care wards in nursing homes
- •Living at a long term care ward for at least 4 weeks before start of the study
排除标准
- •Temporary nursing home patients (i.e. geriatric rehabilitation or end-of-life/hospice care)
- •Life expectancy < 4 weeks
- •Life expectancy clearly > 1.5 - 2 years (i.e. patients with Huntingtons disease)
结局指标
主要结局
Potential under- and overprescribing
时间窗: at baseline - 6 months - 12 months
Potential under- and overprescribing
次要结局
- Experienced involvement in decision-making(At baseline and 2-4 weeks after the medication review)
研究者
Martin Smalbrugge
Principal investigator, professor of Medicine for Older People and chair of the Department of Medicine for Older People
Amsterdam UMC, location VUmc