Bundled Hyperpolypharmacy Deprescribing

Kaiser Permanente

Status

Completed

Conditions

Polypharmacy

Treatments

Other: Bundled hyperpolypharmacy

Study type

Interventional

Funder types

Other

Identifiers

NCT05616689

RDO KPNC 20 - 008

Details and patient eligibility

About

Older patients using many prescription drugs (hyperpolypharmacy) may be at increased risk of adverse drug effects. This randomized controlled trial tested the effectiveness and safety of a quality intervention intended to reduce hyperpolypharmacy. The study was set at Kaiser Permanente Northern California, an integrated health system with multiple pre-existing deprescribing workflows. Eligible patients were aged ≥76 years using ≥10 prescription medications. The intervention included physician-pharmacist collaborative drug therapy management, standard-of-care practice recommendations, shared decision-making, and deprescribing protocols administered by telephone over multiple cycles for a maximum of 180 days after allocation. A priori primary effectiveness endpoints included change in the number of medications and in the prevalence of geriatric syndrome from 181-365 days after allocation. Second endpoints included utilization and adverse drug withdrawal effects. Information was obtained from the electronic health record.

Enrollment

2,471 patients

Sex

All

Ages

76+ years old

Volunteers

Accepts Healthy Volunteers

Inclusion criteria

Kaiser Permanente patients
Age ≥76 years
≥10 drugs (excluding topicals) where
- drug filled ≥2 times in the past year and
- drug last filled < 180 days ago

Exclusion criteria

less than 12 months preceding enrollment at Kaiser Permanente
no primary care practitioner assigned
on dialysis
history of heart, liver, lung, breast, or bone marrow transplant
in hospice
under active treatment for cancer during the past 12 months
has received an intervention through the Pharmacy Targeted Deprescribing Program in the preceding year.