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Nursing home team-care deprescribing study: a stepped-wedge randomised controlled trial protocol
Chong-Han Kua1,2, Cindy Ying Ying Yeo2, Cheryl Wai Teng Char3
1School of Pharmacy, Monash University - Malaysia, Selangor, Malaysia.
BMJ Open
|May 12, 2017
Summary
Deprescribing in nursing homes reduces fall risks and pill burden in elderly patients. This team-care approach improves health outcomes and offers pharmacoeconomic benefits.
Area of Science:
- Geriatric Medicine
- Pharmacoeconomics
- Evidence-Based Practice
Background:
- An ageing Asian population presents challenges, particularly polypharmacy in nursing homes.
- Deprescribing is evidence-based but challenging to implement in geriatric settings.
- Prospective data on deprescribing outcomes in the elderly is scarce.
Purpose of the Study:
- To assess the implementation of team-care deprescribing in nursing homes.
- To evaluate the health and pharmacoeconomic benefits of deprescribing in the elderly.
- To explore factors influencing deprescribing practice.
Main Methods:
- Multicentre prospective study using a cluster randomised stepped-wedge design.
- Team-care deprescribing protocol (review, check, discuss, communicate, document) with a deprescribing guide.
- Assessed primary outcome of fall risks; secondary outcomes included fall rates, pill burden, and medication counts.
Main Results:
- Intervention group showed reduced fall risks and pill burden.
- Significant cost savings were observed through medication cost reduction.
- Qualitative analysis identified key factors affecting deprescribing implementation.
Conclusions:
- Team-care deprescribing is effective in improving geriatric patient outcomes in nursing homes.
- The practice offers significant health and pharmacoeconomic advantages.
- Addressing implementation factors is crucial for successful deprescribing initiatives.
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