Appropriate Prescribing for Older Adults With Multimorbidity (Pro-M): A Feasibility Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 36
- 试验地点
- 4
- 主要终点
- Implementers' attitudes towards the feasibility of the intervention.
研究概览
简要总结
This is a two-site feasibility study to test implementation of an intervention that aims to reduce inappropriate prescribing for older adults with multimorbidity in geriatric medicine specialist clinics at public hospitals in Singapore. The specific aims are:
- To assess the implementation outcomes: Appropriateness, Penetration/Reach, Acceptability, Feasibility, Sustainability (primary)
- To collect data on recruitment and pre-post data on prevalence of potentially inappropriate prescribing (PIP) for the purpose of determining sample size for a scale up next phase study (secondary).
- To conduct cost analysis of the intervention (secondary).
详细描述
The Appropriate prescribing for older adults with multi-morbidity (Pro-M) study aims to assess the feasibility of implementing routine medication review using prescribing criteria for older adults with multi-morbidity at the Geriatric Medicine outpatient clinics at 2 public hospitals in Singapore. The study will consist of a recruitment and implementation period and an evaluation period at the end.
Flow of the intervention (6 months):
- Eligible patients with multimorbidity and are taking at least 5 medications daily will be identified and invited by the doctor to undergo medication review (MR).
- Patients will undergo medication reviews with a pharmacist, involving the use of specific prescribing criteria and tools (e.g. STOPP/START, Beers Criteria), as determined by the sites.
- Medication review findings will be documented in the electronic medical records and shared with the doctor, who will review the findings and make necessary changes to patients' prescriptions during consultations with the patients.
- The Doctors will document the review outcome and prescribing decisions in the electronic medical records and communicate the changes (if any) to other relevant prescribers.
- Patients will be invited to do a short survey on their experiences of the intervention at the end to assess implementation outcomes.
The intervention will be compared to 'usual care', where medication review is only done in an ad-hoc and informal basis. Patients' last consultation prior to the intervention period would be used as the point to measure 'usual care'.
Evaluation(3 months):
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
- 21 Years 至 99 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •for patients:
- •Older adults age 65 and above
- •Currently attending Geriatric Medicine Clinic
- •on at least 5 medications.
排除标准
- •for patients:
- •Those younger than 65
- •Not a Geriatric Medicine outpatient clinic patient
- •On fewer than 5 medications
- •Currently receiving other pharmacist-related services such as medication therapy management.
- •Non-English, non-Chinese, and non-Malay speaking patients.
- •Patient or caregiver who declines any of the study procedure required within the intervention framework.
- •Inclusion Criteria for implementer:
- •Doctors and pharmacists
- •who are involved in the delivery or support of the intervention during the implementation period.
- •Exclusion criteria for implementer:
- •Those who are not involved in the implementation of the study.
- •Those who are not involved in the delivery of the intervention.
结局指标
主要结局
Implementers' attitudes towards the feasibility of the intervention.
时间窗: 3-month Evaluation period: A single-time-point survey to be conducted immediately after the 6-month implementation period. Selected in-depth interviews will follow to provide a qualitative context to the survey results.
The survey consists of 25 items, and each item is measured on a 5-point Likert (level of agreement). This is a mixed method implementation study that is focused on investigating the feasibility of implementing medication reviews as routine care for older adults with multimorbidity in the outpatient clinics. The first 6 months will be the implementation period, followed by a 3-month evaluation period that consists of a survey of the implementers (doctors and pharmacists), then an in-depth interview with selected implementers.
Patients' attitudes towards acceptance of the intervention (Penetration/Reach)
时间窗: A single-time-point survey to be administered immediately after the intervention
The survey consists of 11 items, and each item is on a 5-point Likert scale (level of agreement). This is a mixed method implementation study that is focused on investigating the feasibility of implementing medication reviews as routine care for older adults with multimorbidity in the outpatient clinics. The first 6 months will be the implementation period, followed by a 3-month evaluation period that consists of a first survey of the implementers (doctors and pharmacists), then an in-depth interview with selected implementers.
Implementers' attitudes towards the sustainability of the intervention.
时间窗: 3-month Evaluation period: A single-time-point survey to be conducted immediately after the 6-month implementation period. Selected in-depth interviews will follow to provide a qualitative context to the survey results.
The survey consists of 25 items, and each item is measured on a 5-point Likert (level of agreement). This is a mixed method implementation study that is focused on investigating the feasibility of implementing medication reviews as routine care for older adults with multimorbidity in the outpatient clinics. The first 6 months will be the implementation period, followed by a 3-month evaluation period that consists of a survey of the implementers (doctors and pharmacists), then an in-depth interview with selected implementers.
Implementers' attitudes towards the appropriateness of the intervention
时间窗: 3-month Evaluation period: A single-time-point survey to be conducted immediately after the 6-month implementation period. Selected in-depth interviews will follow to provide a qualitative context to the survey results.
The survey consists of 25 items, and each item is measured on a 5-point Likert (level of agreement). This is a mixed method implementation study that is focused on investigating the feasibility of implementing medication reviews as routine care for older adults with multimorbidity in the outpatient clinics. The first 6 months will be the implementation period, followed by a 3-month evaluation period that consists of a survey of the implementers (doctors and pharmacists), then an in-depth interview with selected implementers.
Implementers' attitudes towards the acceptability of the intervention
时间窗: 3-month Evaluation period: A single-time-point survey to be conducted immediately after the 6-month implementation period. Selected in-depth interviews will follow to provide a qualitative context to the survey results.
The survey consists of 25 items, and each item is measured on a 5-point Likert (level of agreement). This is a mixed method implementation study that is focused on investigating the feasibility of implementing medication reviews as routine care for older adults with multimorbidity in the outpatient clinics. The first 6 months will be the implementation period, followed by a 3-month evaluation period that consists of a survey of the implementers (doctors and pharmacists), then an in-depth interview with selected implementers.
Implementers' views on the fidelity of the intervention.
时间窗: :3-month Evaluation period: A single-time-point survey to be conducted immediately after the 6-month implementation period. Selected in-depth interviews will follow to provide a qualitative context to the survey results.
The survey consists of 25 items, and each item is measured on a 5-point Likert (level of agreement). This is a mixed method implementation study that is focused on investigating the feasibility of implementing medication reviews as routine care for older adults with multimorbidity in the outpatient clinics. The first 6 months will be the implementation period, followed by a 3-month evaluation period that consists of a survey of the implementers (doctors and pharmacists), then an in-depth interview with selected implementers.
次要结局
- Recruitment rate(6 months during implementation period)
- Effectiveness of the intervention: Percentage of patients with at least one PIM before and after intervention.(6 months during implementation period)
- Manpower cost to conduct medication review(6 months during implementation period)
- Effectiveness of the intervention: Percentage of patients with other medication issues identified before and after intervention.(6 months during implementation period)
- Cost of PIM and other medications with issues identified before and after medication review.(6 months during implementation period)