NCT03713112

Efficacy and Feasibility of De-prescribing Rounds in a Singapore Rehabilitative Hospital- a Pilot Randomized Controlled Trial

• Status: Unknown
• Phase: N/A
• Study type: Interventional
• Enrollment: 260 (estimated)
• Sponsor: Bright Vision Hospital · Academic / Other
• Sex: All
• Age: 65 Years – 120 Years
• Healthy volunteers: Accepted

Summary

This open-labelled randomized control trial will be conducted in a Singapore Rehabilitation Hospital to investigate the efficacy, cost-reduction, safety and feasibility of a weekly deprescribing multi-disciplinary inpatient deprescribing round up to 28 days post discharge.

Detailed description

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.

Conditions

• Deprescribing
• Multi-disciplinary
• Rounds

Interventions

Type	Name	Description
OTHER	Weekly MDT deprescribing rounds for certain drugs	* Weekly deprescribing round (from randomization to day of discharge) * Conducted by a multidisciplinary team (non-ward doctors, pharmacist, ward nurse) * Using the 5 steps of de-prescribing * De-prescribing targets: 1. Beer's list of potentially inappropriate medications (American Geriatric Society 2015 version) 2. Supplements of questionable benefits (glucosamine, chondroitin, vitamin B complex and multivitamins) 3. Symptomatic medications (laxatives, gastro-protectives, painkillers, anti-emetics and steroid creams) (Standardized verbal script to initiate de-prescribing by the team) * On top of usual care

Timeline

• Start date: 2018-11-28
• Primary completion: 2019-07-31
• Completion: 2020-06-30
• First posted: 2018-10-19
• Last updated: 2020-05-20

Locations

1 site across 1 country: Singapore