The Impact of a Pharmacist Intervention on Post-discharge Hypnotic Drug Discontinuation in Geriatric Inpatients

Universitaire Ziekenhuizen KU Leuven

Status: Completed

Conditions: Hypnotic Withdrawal

Treatments: Other: Usual care group; Other: multifaceted pharmacist-led intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT05521971

S59134

Details and patient eligibility

About

This study investigated whether a multifaceted approach was associated with hypnotic drug discontinuation at one month after discharge

Full description

Chronic use of hypnotic agents is prevalent in older adults, who as a result are at increased risk for certain adverse events, such as day-time drowsiness and falls. Multiple strategies to discontinue hypnotics have been tested in geriatric patients, but evidence remains scarce. Hence, we aimed to investigate a multicomponent intervention to reduce hypnotic drug use in geriatric inpatients.

A before-after study was performed on the acute geriatric wards of a teaching hospital. The before cohort received usual care while intervention patients were exposed to a pharmacist-led deprescribing intervention, comprising education of health care personnel, access to standardized discontinuation regimens, active patient involvement and support of transitional care. The primary outcome was hypnotic drug discontinuation at one month after discharge.

Enrollment: 173 patients

Sex: All

Ages: 75+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients aged ≥ 75 years
• Admitted to an acute geriatric ward of UZ Leuven
• Documented chronic use of a hypnotic drug (hypnotics were defined as benzodiazepines and Z-drugs and chronic hypnotic drug use was defined as hypnotic use for at least five days a week during a minimum of four consecutive weeks.
• Indication: insomnia, anxiety or an undefined reason

Exclusion criteria

• Concomitant use of multiple benzodiazepines and/or Z-drugs
• Discontinuation of the hypnotic drug prior to enrollment
• Estimated discharge from the hospital within 72 hours of admission
• No command of the Dutch language
• Severe psychiatric or neurological disease (e.g. bipolar disorder, epilepsy or dystonia) or a severe acute medication condition in the opinion of the treating physician
• End-of-life care.

Study participants who died during their hospital stay were excluded from the analysis as their medication at discharge could not be evaluated. In case of any readmission, only the first admission was included in the analysis.

Trial design

Primary purpose: Prevention

Allocation: Non-Randomized

Interventional model: Sequential Assignment

Masking: None (Open label)

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173 participants in 2 patient groups

Before group

Other group

Description:

In the usual care cohort, there was no systematic clinical pharmacist involvement regarding deprescribing of hypnotics.

Treatment:

Other: Usual care group

After group

Experimental group

Description:

In the intervention cohort a pharmacist-led intervention was implemented comprising the four following components: 1) education of health care personnel; 2) access to standardized discontinuation regimens; 3) patient education; 4) support of transitional care.

Treatment:

Other: multifaceted pharmacist-led intervention