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

Bright Vision Hospital

Status: Unknown

Conditions: Deprescribing; Multi-disciplinary; Rounds

Treatments: Other: Weekly MDT deprescribing rounds for certain drugs

Study type: Interventional

Funder types: Other

Identifiers

NCT03713112

CIRB Ref 2018/2721

Details and patient eligibility

About

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.

Full 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.

Enrollment: 260 estimated patients

Sex: All

Ages: 65 to 120 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Greater or equals to 65 years old
• Newly admitted to rehabilitation or sub-acute disciplines
• Possess 1 or more of the targeted medications

Exclusion criteria

• Abbreviated mental test less than 7
• No mental capacity

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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260 participants in 2 patient groups

Weekly MDT deprescribing rounds

Active Comparator group

Description:

Weekly MDT deprescribing rounds for certain drugs will be performed on top of usual care.

Treatment:

Other: Weekly MDT deprescribing rounds for certain drugs

Control (Usual Care)

No Intervention group

Description:

Usual Care includes the following: De-prescribing at the discretion of the ward doctors Initial medication reconciliation by pharmacist on admission Ward rounds to be conducted 3 weekdays per week for rehabilitative patients and daily on weekdays for sub-acute patients.