Nursing home team-care deprescribing study: a stepped-wedge randomised controlled trial protocol.

Autor:	Kua CH; School of Pharmacy, Monash University - Malaysia, Selangor, Malaysia.; Continuing and Community Care Department, Tan Tock Seng Hospital, Singapore., Yeo CYY; Continuing and Community Care Department, Tan Tock Seng Hospital, Singapore., Char CWT; National Healthcare Group Pharmacy, Singapore., Tan CWY; National Healthcare Group Pharmacy, Singapore., Tan PC; National Healthcare Group Pharmacy, Singapore., Mak VS; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia., Lee SWH; School of Pharmacy, Monash University - Malaysia, Selangor, Malaysia., Leong IY; Continuing and Community Care Department, Tan Tock Seng Hospital, Singapore.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2017 May 09; Vol. 7 (5), pp. e015293. Date of Electronic Publication: 2017 May 09.
DOI:	10.1136/bmjopen-2016-015293
Abstrakt:	Introduction: An ageing population has become an urgent concern for Asia in recent times. In nursing homes, polypharmacy has also become a compounding issue. Deprescribing practice is an evidence-based strategy to provide a better outcome in this group of patients; however, its implementation in nursing homes is often challenging, and prospective outcome data on deprescribing practice in the elderly is lacking. Our study assesses the implementation of team-care deprescribing to understand the benefits of this practice in geriatric setting and to explore the factors affecting deprescribing practice. Methods and Analysis: This multicentre prospective study consists of a prestudy interview questionnaire, and a preintervention and postintervention study to be conducted in the nursing home setting on residents at least 65 years old and on five or more medications. We will employ a cluster randomised stepped-wedge interventional design, based on a five-step (reviewing, checking, discussion, communication and documentation) team-care deprescribing practice coupled with the use of a deprescribing guide (consisting of Beers and STOPP criteria, as well as drug interaction checking), to assess the health and pharmacoeconomic outcome in nursing homes' practice. Primary outcome measures of the intervention will consist of fall risks using a fall risk assessment tool. Other outcomes assessed include fall rates, pill burden including number of pills per day, number of doses per day and number of medications prescribed. Cost-related measures will include the use of cost-benefit analysis, which is calculated from the medication cost savings from deprescribing. For the prestudy interview questionnaire, findings will be analysed qualitatively using thematic analysis. Ethics and Dissemination: This study is approved by the Domain Specific Review Board of National Healthcare Group, Singapore (2016/00422) and Monash University Human Research Ethics Committee (2016-1430-7791). The study findings shall be disseminated in international conferences and peer-reviewed publications. The study is registered with ClinicalTrials.gov (NCT02863341), Pre-results. Competing Interests: Competing interests: None declared. (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
Databáze:	MEDLINE
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