TY - JOUR
T1 - Impact of deprescribing intervention on potentially inappropriate medications and clinical outcomes among hospitalized older adults in Malaysia
T2 - a randomized controlled trial (REVMED RCT) protocol
AU - Chang, Chee Tao
AU - Teoh, Siew Li
AU - Cheah, Wee Kooi
AU - Lee, Pei Jia
AU - Azman, Muhammad Azuan
AU - Ling, Shiau Hui
AU - Chuah, Angie Su Ching
AU - Sabki, Noor Hamizah
AU - George, Doris
AU - Oh, Hoey Lin
AU - Goh, Jing Yi
AU - Lee, Siew Huang
AU - Foong, Wai Keng
AU - Lee, Jason Choong Yin
AU - Chan, Huan Keat
AU - Teoh, Lee Rhui
AU - Lim, Xin Jie
AU - Rajan, Philip
AU - Lee, Shaun Wen Huey
N1 - Funding Information:
We would like to thank the Director General of Health Malaysia for his permission to publish this article.
Publisher Copyright:
© 2023, Dr. Zaheer-Ud-Din Babar and Auckland UniServices Ltd.
PY - 2023/12
Y1 - 2023/12
N2 - Background: Polypharmacy and the use of potentially inappropriate medications (PIMs) are prevalent among older patients admitted to hospitals, posing a heightened risk of adverse drug events. This trial aims to evaluate the effectiveness of a pharmacist-led deprescribing intervention in reducing medications, PIM and improving clinical outcomes, using the locally developed Malaysian Potentially Inappropriate Prescribing Screening tool in Older Adults (MALPIP). Methods: This is an 18-month cluster-randomized, open-label, parallel-arm controlled trial conducted at 14 public hospitals in the Perak state of Malaysia. Patients aged 60 and above, who have at least one medication and one comorbidity are eligible. A stratified-cluster randomization design is employed, with 7 hospitals assigned to the control arm and 7 hospitals assigned to the intervention arm. The MALPIP screening tool will be used in the intervention group to review the medications. If PIM is detected, the pharmacists will discuss with doctors and decide whether to stop or reduce the dose. The primary outcomes of this trial are the total number of medications and number of PIM. The secondary outcomes include fall, emergency department visits, readmissions, quality of life and mortality. Outcomes will be measured during enrolment, discharge, 6, 12, and 18 months. Discussion: This REVMED trial aims to test the hypothesis that a pharmacist-led deprescribing intervention initiated in the hospital will reduce the total number of medications and PIM 18 months after hospital discharge, reducing fall, emergency department visits, readmissions, mortality and lead to improvement in quality of life. Trial findings will quantify the clinical outcomes associated with reducing medications and PIM for hospitalized older adults with polypharmacy. Trial registration number: This trial was prospectively registered at clinicaltrials.gov (NCT05875623) on the 25th of May 2023. NCT05875623 Clinicaltrials.gov URL: NCT05875623 registered on 25th July 2023.
AB - Background: Polypharmacy and the use of potentially inappropriate medications (PIMs) are prevalent among older patients admitted to hospitals, posing a heightened risk of adverse drug events. This trial aims to evaluate the effectiveness of a pharmacist-led deprescribing intervention in reducing medications, PIM and improving clinical outcomes, using the locally developed Malaysian Potentially Inappropriate Prescribing Screening tool in Older Adults (MALPIP). Methods: This is an 18-month cluster-randomized, open-label, parallel-arm controlled trial conducted at 14 public hospitals in the Perak state of Malaysia. Patients aged 60 and above, who have at least one medication and one comorbidity are eligible. A stratified-cluster randomization design is employed, with 7 hospitals assigned to the control arm and 7 hospitals assigned to the intervention arm. The MALPIP screening tool will be used in the intervention group to review the medications. If PIM is detected, the pharmacists will discuss with doctors and decide whether to stop or reduce the dose. The primary outcomes of this trial are the total number of medications and number of PIM. The secondary outcomes include fall, emergency department visits, readmissions, quality of life and mortality. Outcomes will be measured during enrolment, discharge, 6, 12, and 18 months. Discussion: This REVMED trial aims to test the hypothesis that a pharmacist-led deprescribing intervention initiated in the hospital will reduce the total number of medications and PIM 18 months after hospital discharge, reducing fall, emergency department visits, readmissions, mortality and lead to improvement in quality of life. Trial findings will quantify the clinical outcomes associated with reducing medications and PIM for hospitalized older adults with polypharmacy. Trial registration number: This trial was prospectively registered at clinicaltrials.gov (NCT05875623) on the 25th of May 2023. NCT05875623 Clinicaltrials.gov URL: NCT05875623 registered on 25th July 2023.
KW - Deprescribing
KW - Fall
KW - Geriatrics
KW - Polypharmacy
KW - Potentially inappropriate medications
KW - Quality of life
KW - Readmission
UR - http://www.scopus.com/inward/record.url?scp=85173773004&partnerID=8YFLogxK
U2 - 10.1186/s40545-023-00621-5
DO - 10.1186/s40545-023-00621-5
M3 - Article
AN - SCOPUS:85173773004
SN - 2052-3211
VL - 16
JO - Journal of Pharmaceutical Policy and Practice
JF - Journal of Pharmaceutical Policy and Practice
IS - 1
M1 - 113
ER -