Efficacy and Feasibility of De-prescribing Rounds in a Singapore Rehabilitative Hospital- a Pilot Randomized Controlled Trial
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|ClinicalTrials.gov Identifier: NCT03713112|
Recruitment Status : Recruiting
First Posted : October 19, 2018
Last Update Posted : December 6, 2018
|Condition or disease||Intervention/treatment||Phase|
|Deprescribing Multi-disciplinary Rounds||Other: Weekly MDT deprescribing rounds for certain drugs||Not Applicable|
ABSTRACT BACKGROUND: Deprescribing has been effective and safe in reducing polypharmacy and morbidity (e.g. fall), especially amongst elderly. However, little has been studied about the efficacy of a regular multidisciplinary round in deprescribing predefined medications in Singapore rehabilitative hospitals.
AIM: This study aims to evaluating the effects of a weekly multidisciplinary team(MDT) de-prescribing round on the reduction on total daily dose, cost of medications, its safety and feasibility in a Singapore rehabilitative hospital.
Methods: A total of 260 newly admitted patients will be randomised to a de-prescribing intervention (n= 130) or control (usual care) group (n= 130), using GraphPad randomization sequence software ©2017. The 5 steps of deprescribing process will be used and the targets of deprescribing are Beer's list of potentially inappropriate medications (AGS 2015 version), predetermined supplements and symptomatic medications. Predetermined medications were deprescribed following initial MDT assessment, discussion with attending doctors and consideration of patients' preferences regarding discontinuation or dose reduction. Total daily dose reduction, cost and side effects of deprescribing were monitored on admission day 14, 28, discharge day and post-discharge day 28. Time required for such rounds are also measured.
IMPACT: Once proven successful, this effective model of deprescribing could safely help to cut down caregiver's medicine administrative burden, improve compliance and reduce national healthcare cost. This model could also be easily replicated in all Singapore rehabilitative hospitals.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||260 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||The 2 arms of rehabilitative and/or subacute care patients consist of the intervention arm (receiving weekly multidisciplinary rounds up to the point of discharge, using 5 steps of deprescribing at the bedside, targeted to deprescribe selected medications [Beers' List of inappropriate Medications 2015; selected supplements and selected symptomatic medications]) and control arm (receving usual care)|
|Masking:||None (Open Label)|
|Official Title:||Efficacy and Feasibility of De-prescribing Rounds in a Singapore Rehabilitative Hospital- a Pilot Randomized Controlled Trial|
|Actual Study Start Date :||November 28, 2018|
|Estimated Primary Completion Date :||August 20, 2019|
|Estimated Study Completion Date :||August 20, 2019|
Active Comparator: Weekly MDT deprescribing rounds
Weekly MDT deprescribing rounds for certain drugs will be performed on top of usual care.
Other: Weekly MDT deprescribing rounds for certain drugs
No Intervention: Control (Usual Care)
Usual Care includes the following:
- Change in total daily dose of medication upon discharge from the hospital [ Time Frame: During the patient's inpatient stay (this will be measured on the day of discharge, usually ranging between 21 to 49 days upon inpatient admission) ]Change in total daily dose of medication upon discharge from the hospital
- Cost savings measured in Singapore dollars [ Time Frame: These outcomes will be measured on days 14, 28 of inpatient admission, the day of inpatient discharge (*this is usually between 21 to 49 days after admission) and day 28 post discharge. Overall timeframe ranges between 49 to 77days after admission. ]Cost savings measured in Singapore dollars
- Number of participants with side effects from deprescribing [ Time Frame: These outcomes will be measured on days 14, 28 of inpatient admission, the day of inpatient discharge (*this is usually between 21 to 49 days after admission) and day 28 post discharge. Overall timeframe ranges between 49 to 77days after admission. ]Number of participants with side effects from deprescribing (i.e. recurrence of medical indications or symptoms; withdrawal effects of deprescribing; reinstating the same medications or substituting another medication, hospitalization and death)
- feasibility of intervention in terms of time taken, measured in minutes. [ Time Frame: During the patient's inpatient stay (this will be measured on the day of discharge, usually ranging between 21 to 49 days upon inpatient admission) ]The feasibility of implementation of intervention will also be determined through the time required to complete the de-prescribing process, measured in minutes.
- feasibility of intervention in terms of ease at which the rounds are conducted (descriptive) [ Time Frame: During the patient's inpatient stay (this will be measured on the day of discharge, usually ranging between 21 to 49 days upon inpatient admission) ]The feasibility of implementation of intervention will also be determined through limitations and challenges encountered, as documented by the multidisciplinary team.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03713112
|Contact: Wong Peng Yong, Andrew, MBBS||62485755 ext email@example.com|
|Contact: Belinda Soh Qimin||62485755 ext firstname.lastname@example.org|
|Bright Vision Hospital||Recruiting|
|Singapore, Singapore, 547530|
|Contact: Wong Peng Yong, Andrew, MBBS 62485755 ext 5749 email@example.com|
|Contact: Belinda Soh Qimin 62485755 firstname.lastname@example.org|
|Sub-Investigator: Charissa Ann Ee Jia Ming|
|Sub-Investigator: Tan Wanting|
|Sub-Investigator: Low Lian Leng, MBBS|
|Principal Investigator: Wong Peng Yong, Andrew, MBBS|
|Principal Investigator:||Wong Peng Yong, Andrew, MBBS||Bright Vision Hospital; Singhealth Community Hospitals|