Deprescribing in Patients Living With Dementia With Caregiver and Provider Nudges
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 262
- 试验地点
- 2
- 主要终点
- Composite of the percentage of eligible PCPs or their PLWD/care partners who view or click on information
研究概览
简要总结
The objectives of this study are to demonstrate the feasibility of implementing a deprescribing nudge intervention using pragmatic methods, confirm that outcomes can be feasibly measured and evaluated at scale in a subsequent embedded pragmatic clinical trial (ePCT), and explore representativeness of persons living with dementia and care partners identified.
详细描述
The PCP nudge will consist of: a 'pre-commitment' EHR nudge triggered when a PCP opens a patient encounter (i.e., prompt to first have a discussion and then later deprescribe) and a brief message within the in-basket prior to upcoming visits including information about their patient. The patient living with dementia (PLWD)/care partner nudge will include an electronic message delivered prior to upcoming visits (in their primary language recorded in the EHR) that includes a recommendation for the PLWD (and care partner, if available) to discuss medications with the PCP at the visit.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- None
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
- •Providers within Brigham and Women's Hospital primary care practices
- •Having prescribed at least one of the high-risk medications of interest
- •Eligible patients will be identified through this providers within the health care system.
- •Patient inclusion criteria:
- •At least 65 years of age
- •Prescribed at least 90 pills of one of the high-risk medications of interest in the last 180 days in the EHR system, which most guidelines consider chronic use, and have a diagnosis of dementia in the EHR.
排除标准
- 未提供
研究组 & 干预措施
Nudge internvention
PCPs will receive an enhanced EHR alert (nudge) that triggers when a PCP opens an encounter for an eligible patient living with dementia (PLWD). The nudge will provide information about the risks of continued medication use as well as tips and tools to help providers discuss medication discontinuation with patients and care partners. Additionally, the providers will receive a brief message in their in-basket 10 days before the patient's appointment as a reminder.
Eligible PLWD of a randomized PCP will receive the nudge intervention which includes a brief recommendation for the PLWD (and care partner, if available) via the linked patient portal prior to upcoming visits (unless explicitly opted out by the PCP) to discuss medications with the PCP at the visit and link to a general handout about medications, unless explicitly opted out by the PCP. For PLWD without a portal account, the handout will be sent to their mailing address recorded in the EHR.
干预措施: Nudge Intervention (Behavioral)
结局指标
主要结局
Composite of the percentage of eligible PCPs or their PLWD/care partners who view or click on information
时间窗: On or before the primary care provider visit
This will be the primary progression criteria for the study and measured and evaluated separately by patient and provider.
Composite of the Percentage of Eligible PCPs or Their PLWD/Care Partners Who View or Click on Information on or Before the Primary Care Provider Visit, up to 10 Days
时间窗: On or before the primary care provider visit, up to 10 days
This is the primary progression criteria for the study, measured on the patient level. This is measured as a composite of the number of eligible PCPs or their PLWD/care partners who view or click on information on or before the primary care provider visit, up to 10 days
次要结局
- Number of nudges that fire as intended: Fidelity(On the primary care provider visit)
- Discontinuation or prescribed reduction in medication(Within 60 days after the primary care provider visit)
- Number of Patients With Nudges That Fire as Intended: Fidelity(On the primary care provider visit date)
- Discontinuation or Prescribed Reduction in Medication(Within 60 days on or after the primary care provider visit)
研究者
Julie Lauffenburger
Associate Professor
Brigham and Women's Hospital