A Trial to De-prescribe Inappropriate Medications in the Community Dwelling Elderly (D-PRESCRIBE)

University Institute of Geriatrics of Montreal (IUGM)

Status and phase: Completed; Phase 4

Conditions: Inappropriate Dose of Drug Administered; Health Behavior

Treatments: Behavioral: Pharmacist-led educational intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT02053194

CIHR 201303MOP-299872-KTR

Details and patient eligibility

About

The objective of this trial is to test the beneficial effect of a pharmacist-initiated knowledge transfer intervention to both patients and prescribers on the discontinuation of inappropriate prescriptions, compared to usual care. The investigators hypothesize that the pharmacist-led intervention will reduce inappropriate prescriptions by at least 20% over 6-months compared to usual care. The intervention consists of simultaneously educating consumers and providing physicians with an evidence-based pharmaceutical opinion on inappropriate prescriptions.

Enrollment: 600 patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Men and women 65 years of age and older (no upper age limit)
• Individuals for whom prescription claims derive from only one pharmacy identifier
• Chronic consumption (> 3 month claims) of one of the target inappropriate prescriptions. (benzodiazepine/non benzodiazepine hypnotic, long-acting sulfonylurea oral hypoglycemic agents, anticholinergic agents (in the form of first-generation antihistamines) or Nonsteroidal anti-inflammatory drugs [NSAIDs] )
• Patients who are willing to participate in the study.

Exclusion criteria

• A probable diagnosis of dementia (persons without the capacity to provide informed consent), as determined by a) a prescription for memantine or a cholinesterase inhibitor; b) report from a caregiver or family-member; or c) a baseline screening score on the Folstein Mini-Mental State Exam < 24
• Inability to understand and or communicate in English and/or French
• Patients living in a long-term care facility
• Concomitant use of any antipsychotic medication

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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600 participants in 2 patient groups

Pharmacist-led educational intervention

Experimental group

Description:

Participants will receive an educational brochure on an inappropriate prescription they are currently taking from their pharmacists. Participants' physicians will receive an evidence-based pharmaceutical opinion for the same medication.

Treatment:

Behavioral: Pharmacist-led educational intervention

Control

No Intervention group

Description:

Participants in the control group will be wait-listed and observed for 6 months prior to receiving the intervention.