Improved Prescribing for Older Nursing Home Patients (IMPETUS)

Amsterdam UMC, location VUmc

Status: Enrolling

Conditions: Decision Making; Older People; Medication Reviews; Advance Care Planning; Nursing Home Residents; Prescribing; Prescribing Practices

Treatments: Combination Product: Systematic multidisciplinary medication review + ACP (SMMR+)

Study type: Interventional

Funder types: Other

Identifiers

NCT06731361

839160003

Details and patient eligibility

About

Research aim:

To investigate the effect of training health care professionals in medication assessments on the medication use of nursing home residents with a limited life expectancy (< 1.5-2 years).

The core of the training is to tailor medication use to (palliative) treatment goals of nursing home residents.

Design:

A cluster randomized controlled trial on long term care wards in nursing homes, with the nursing home care organisations as unit of randomisation. The investigators intent to include 6 organisations and 450 nursing home patients. The research starts in september and lasts 1 year and 3 months. Eligible patients are nursing home patients of 65 years and older with a limited life expectancy (< 1.5-2 year) of long term care wards.

Intervention:

The intervention includes a method in which healthcare professionals (medical practitioner, pharmacist and care worker) are trained to tailor medication to the (palliative) treatment goals of nursing home patients with a limited life expectancy. The training consists of 2 components: 1) medication assessment, and 2) advance care planning (ACP). In the intervention group, healthcare professionals receive the training in combination with supporting tools and educational materials, in the control group care continues as normal. The allocation ratio for control and intervention groups is 1:1. A process evaluation will take place simultaneously with the intervention study. Data collection takes place before the start of the intervention (T0), after 6 months (T1) and after 12 months (T2).

Outcome measures:

The primary outcome measure is potential under- and over-treatment with medication. The secondary outcome measure is experienced involvement in decision-making (measured with a short questionnaire based on the revised PATD (patients' attitude towards deprescribing)). Tertiary outcome measures are: quality of life, deaths, falls, hospital admissions/acute first aid referrals and pain.

Discussion:

The intervention is expected to result in a decrease in chronic and preventive medication prescriptions, an increase in medication for symptom treatment and more involvement (and satisfaction) of the nursing home resident in decision-making, without adverse effects.

Full description

Additional information on the method:

We included 2 nursinghome organizations in september, 2 in october, and 3 in november.

Enrollment: 450 estimated patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

Nursing home patients:

• Age 65years and above
• Living at long term care wards in nursing homes
• Living at a long term care ward for at least 4 weeks before start of the study

Exclusion criteria

• Temporary nursing home patients (i.e. geriatric rehabilitation or end-of-life/hospice care)
• Life expectancy < 4 weeks
• Life expectancy clearly > 1.5 - 2 years (i.e. patients with Huntingtons disease)

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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450 participants in 2 patient groups

Control

No Intervention group

Description:

Control group, care as usual

Educational intervention

Experimental group

Description:

The clusters that fall into the experimental arm receive the educational intervention: they receive an in-house training in combination with supporting tools, educational materials and intervision moments.

Treatment:

Combination Product: Systematic multidisciplinary medication review + ACP (SMMR+)