Deprescribing in nursing homes: Protocol for nested, randomised controlled hybrid trials of deprescribing interventions

Damien Cateau; Pierluigi Ballabeni; Stephanie Mena; Olivier Bugnon; Anne Niquille

doi:10.1016/j.sapharm.2020.05.026

Deprescribing in nursing homes: Protocol for nested, randomised controlled hybrid trials of deprescribing interventions

Res Social Adm Pharm. 2021 Apr;17(4):786-794. doi: 10.1016/j.sapharm.2020.05.026. Epub 2020 May 27.

Authors

Damien Cateau¹, Pierluigi Ballabeni², Stephanie Mena³, Olivier Bugnon³, Anne Niquille⁴

Affiliations

¹ Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Switzerland. Electronic address: damien.cateau@unisante.ch.
² Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland.
³ Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Switzerland.
⁴ Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Switzerland.

PMID: 32622774
DOI: 10.1016/j.sapharm.2020.05.026

Abstract

Introduction: Polypharmacy and the use of potentially inappropriate medication (PIMs) are frequent among nursing home (NH) residents, and are associated with adverse health outcomes like falls, hospitalisation and death. Deprescribing has been proposed as a way to curtail both problems; however, the best way to implement deprescribing and its real impact are still unclear. This article describes nested trials of two consecutive deprescribing interventions, the first at the NH level, and the second at the resident level.

Methods and analysis: The first intervention (QC-DeMo) will be a deprescribing module to be carried out in existing interprofessional quality circles in NHs, with the goal to develop a NH-wide deprescribing consensus. Its effects will be evaluated on the use of PIMs and on patient safety outcomes such as death, hospitalisation and falls. All NHs in the cantons of Vaud and Fribourg with an integrated pharmacy service will be eligible. The second intervention (IDeI), at the resident level, will be a deprescribing-focused medication review, resulting in the implementation of a deprescribing plan. Its effects will be evaluated on the use of PIMs and chronic medications, and on quality of life. This second trial will take place in the NHs allocated to the intervention group of the first trial. All residents of these NHs over 65 years old, living in the NH for at least 4 months, and taking 5 or more medications will be eligible to participate. Both trials will be hybrid effectiveness and implementation trials, aiming to understand the implementation process for the interventions, and to identify barriers and facilitators.

Ethics, registration and funding: Both trials were approved by the relevant ethics committee, registered on ClinicalTrials.gov (QC-DeMo: NCT03688542; IDeI: NCT03655405), and funded by the Swiss National Fund for Scientific Research.

Keywords: Deprescriptions; Nursing homes; Patient safety; Pharmaceutical services; Potentially inappropriate medication list.

Publication types

Clinical Trial Protocol
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Deprescriptions*
Humans
Nursing Homes
Polypharmacy
Potentially Inappropriate Medication List
Quality of Life

Associated data

ClinicalTrials.gov/NCT03688542
ClinicalTrials.gov/NCT03655405