FeasibilityEfficacy of Deprescribing rounds in a Singapore rehabilitative hospital- a randomised controlled trial
| Autor: | Kwan Yu Heng, Tan Wee Boon, Low Lian Leng, Andrew Peng Yong Wong, Ee Jia Ming Charissa, Tan Wan Ting |
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| Rok vydání: | 2021 |
| Předmět: |
Rehabilitation hospital
medicine.medical_specialty Constipation medicine.medical_treatment Hospitals Rehabilitation Aftercare Multidisciplinary team law.invention Deprescriptions Randomized controlled trial Deprescribing Open label law Medicine Humans Rounds Aged Polypharmacy Randomised controlled trial Singapore Rehabilitation business.industry Research RC952-954.6 Patient Discharge Geriatrics Physical therapy Feasibility Studies Female Geriatrics and Gerontology medicine.symptom business |
| Zdroj: | BMC Geriatrics BMC Geriatrics, Vol 21, Iss 1, Pp 1-11 (2021) |
| ISSN: | 1471-2318 |
| Popis: | Background Deprescribing is effective and safe in reducing polypharmacy among the elderly. However, the impact of deprescribing rounds remain unclear in Asian settings. Hence, we conducted this study. Methods An open label randomised controlled trial was conducted on patients of 65 years and above, under rehabilitation or subacute care and with prespecified medications from a Singapore rehabilitation hospital. They were randomised using a computer generated sequence. The intervention consisted of weekly multidisciplinary team-led deprescribing rounds (using five steps of deprescribing) and usual care. The control had only usual care. The primary outcome is the percentage change in total daily dose (TDD) from baseline upon discharge, while the secondary outcomes are the total number of medicine, total daily cost and TDD up to day 28 postdischarge, overall side-effect rates, rounding time and the challenges. Efficacy outcomes were analysed using intention-to-treat while other outcomes were analysed as per protocol. Results 260 patients were randomised and 253 were analysed after excluding dropouts (female: 57.3%; median age: 76 years). Baseline characteristics were largely similar in both groups. The intervention arm (n = 126) experienced a greater reduction of TDD on discharge [Median (IQR): − 19.62% (− 34.38, 0.00%) versus 0.00% (− 12.00, 6.82%); p p = 0.009) though death and hospitalisation rates were similar. The median rounding time was 7.09 min per patient and challenges include the inconvenience in assembling the multidisciplinary team. Conclusion Deprescribing rounds can safely reduce TDD of medicine upon discharge compared to usual care in a Singaporean rehabilitation hospital. Trial registration This study is first registered at Clinicaltrials.gov (protocol number: NCT03713112) on 19/10/2018 and the protocol can be accessed on https://www.clinicaltrials.gov. |
| Databáze: | OpenAIRE |
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