Discontinuing Inappropriate Medication in Nursing Home Residents
- Conditions
- Polypharmacy Because of Multimorbidity in Geriatric Nursing Home Residents
- Interventions
- Procedure: Multidisciplinary medication review
- Registration Number
- NCT01876095
- Lead Sponsor
- University of Groningen
- Brief Summary
Nursing home residents are among the frailest patient groups with a high number of co-morbidities and a high use of medicines. Inappropriate polypharmacy (i.e. often overprescribing) is one of the major problems in the nursing home population increasing the number of adverse drug reactions, falls, hospital admissions, mortality as well as having an impact on health care utilization. Multidisciplinary medication reviews have a great potential to reduce inappropriate medication use. The purpose of this study is to determine the efficacy of a multidisciplinary medication review model focussing on discontinuing inappropriate medication in a cluster randomized controlled trial in 600 nursing home residents. The primary outcome measure is the difference in proportion of residents who successfully discontinued medication between intervention and control group after four months. Secondary outcome measures will be the drug burden index, adverse drug withdrawal events related to the discontinued medication, death, referral to hospitals and quality of life.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 992
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Multidisciplinary medication review Multidisciplinary medication review The multidisciplinary medication review consists of 5 steps: Step #1: Assessing patients' experiences and preferences regarding medicine use en assessing their medical history, allergies and lab results Step #2: Drug reviewing to assess contra-indicated medication and duplicate medication using consensus criteria e.g. START STOPP Beers criteria Step #3: Reflecting on results of drug reviewing Step #4: Setting up a pharmacotherapeutical action plan Step #5: Execution of pharmacotherapeutical action plan
- Primary Outcome Measures
Name Time Method Successful medication discontinuation 4 months The number of residents for whom ≥1 inappropriate medication(s) are succesfully discontinued i.e. without relapse or severe withdrawal effects
- Secondary Outcome Measures
Name Time Method Dose adjustment 4 months Number of residents for whom ≥1 dose(s) are lowered or increased
Death 4 months Incidence of death
Safer alternative medication 4 months The percentage of residents for whom ≥1 medication(s) is replaced by a safer alternative
Bone fractures 4 months Bone fractures caused by falling
Drug burden index 4 months A measure of a person's cumulative exposure to anticholinergic and sedative medications, which has been associated with falls in nursing home patients
Quality of Life 4 months Quality of life will be measured using a disease specific instrument (DQI (Scholzel-Dorenbosch et al, in press) and a generic instrument EQ-5D-5L for all patients (Herdman et al, 2011).
adverse drug withdrawal events 4 months The rate of adverse drug withdrawal events related to the discontinued medication
Hospital admission 4 months Hospital admission
Falling 4 months Defined as any event in which a nursing home resident touches the ground in an unintentional sudden manner without cues of emergency
number of visits to outpatient clinics / emergency rooms / by medical consultants 4 months number of visits to outpatient clinics, emergency rooms, number of visits by medical consultants i.e. physicians who visit the patients in the nursing homes,
Medication initiation 4 months Number of residents for whom ≥1 medication(s) are initiated (s) that should be started on the basis of the Screening Tool to Alert doctors to Right Treatment (START) criteria
Trial Locations
- Locations (1)
University of Groningen
🇳🇱Groningen, Netherlands