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Nursing home team-care deprescribing study: a stepped-wedge randomised controlled trial protocol
  1. Chong-Han Kua1,2,
  2. Cindy Ying Ying Yeo2,
  3. Cheryl Wai Teng Char3,
  4. Cheryl Wei Yan Tan3,
  5. Poh Ching Tan3,
  6. Vivienne SL Mak4,
  7. Shaun Wen Huey Lee1,
  8. Ian Yi-Onn Leong2
  1. 1 School of Pharmacy, Monash University – Malaysia, Selangor, Malaysia
  2. 2 Continuing and Community Care Department, Tan Tock Seng Hospital, Singapore
  3. 3 National Healthcare Group Pharmacy, Singapore
  4. 4 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
  1. Correspondence to Mr. Chong-Han Kua; chong.kua{at}monash.edu

Abstract

Introduction An ageing population has become an urgent concern for Asia in recent times. In nursing homes, polypharmacy has also become a compounding issue. Deprescribing practice is an evidence-based strategy to provide a better outcome in this group of patients; however, its implementation in nursing homes is often challenging, and prospective outcome data on deprescribing practice in the elderly is lacking. Our study assesses the implementation of team-care deprescribing to understand the benefits of this practice in geriatric setting and to explore the factors affecting deprescribing practice.

Methods and analysis This multicentre prospective study consists of a prestudy interview questionnaire, and a preintervention and postintervention study to be conducted in the nursing home setting on residents at least 65 years old and on five or more medications. We will employ a cluster randomised stepped-wedge interventional design, based on a five-step (reviewing, checking, discussion, communication and documentation) team-care deprescribing practice coupled with the use of a deprescribing guide (consisting of Beers and STOPP criteria, as well as drug interaction checking), to assess the health and pharmacoeconomic outcome in nursing homes’ practice. Primary outcome measures of the intervention will consist of fall risks using a fall risk assessment tool. Other outcomes assessed include fall rates, pill burden including number of pills per day, number of doses per day and number of medications prescribed. Cost-related measures will include the use of cost–benefit analysis, which is calculated from the medication cost savings from deprescribing. For the prestudy interview questionnaire, findings will be analysed qualitatively using thematic analysis.

Ethics and dissemination This study is approved by the Domain Specific Review Board of National Healthcare Group, Singapore (2016/00422) and Monash University Human Research Ethics Committee (2016-1430-7791). The study findings shall be disseminated in international conferences and peer-reviewed publications. The study is registered with ClinicalTrials.gov (NCT02863341), Pre-results

  • Deprescribing
  • Elderly
  • Falls
  • Multidisciplinary
  • Nursing home
  • Polypharmacy

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors C-HK drafted the manuscript and is the principal investigator. C-HK, CYYY, SWHL, VSLM and IY-OL participated in the design of the study presented in the manuscript. C-HK, CYYY, CWTC, CWYT and PCT will be conducting the study. All authors have reviewed and approved the manuscript.

  • Competing interests None declared.

  • Ethics approval Domain Specific Review Board (DSRB) Singapore and Monash University Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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