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. 2023 Oct 3;16(1):113.
doi: 10.1186/s40545-023-00621-5.

Impact of deprescribing intervention on potentially inappropriate medications and clinical outcomes among hospitalized older adults in Malaysia: a randomized controlled trial (REVMED RCT) protocol

Chee Tao Chang  1   2 , Siew Li Teoh  3 , Wee Kooi Cheah  4   5 , Pei Jia Lee  6 , Muhammad Azuan Azman  6 , Shiau Hui Ling  7 , Angie Su Ching Chuah  7 , Noor Hamizah Sabki  8 , Doris George  8 , Hoey Lin Oh  9 , Jing Yi Goh  9 , Siew Huang Lee  10 , Wai Keng Foong  11 , Jason Choong Yin Lee  12 , Huan Keat Chan  13 , Lee Rhui Teoh  14 , Xin Jie Lim  15 , Philip Rajan  15 , Shaun Wen Huey Lee  3
Affiliations

Impact of deprescribing intervention on potentially inappropriate medications and clinical outcomes among hospitalized older adults in Malaysia: a randomized controlled trial (REVMED RCT) protocol

Chee Tao Chang et al. J Pharm Policy Pract. .

Abstract

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.

Keywords: Deprescribing; Fall; Geriatrics; Polypharmacy; Potentially inappropriate medications; Quality of life; Readmission.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

Fig. 1
Fig. 1
Distribution of 14 public hospitals across 10 districts in Perak State: treatment allocation, annual admission, and sample size
Fig. 2
Fig. 2
Flow of study subjects
Fig. 3
Fig. 3
Four-step pharmacist-led deprescribing framework
See this image and copyright information in PMC

References

    1. Cheng X, Yang Y, Schwebel DC, Liu Z, Li L, Cheng P, et al. Population ageing and mortality during 1990–2017: a global decomposition analysis. PLoS Med. 2020;17:e1003138. doi: 10.1371/journal.pmed.1003138. - DOI - PMC - PubMed
    1. Chang C-T, Mohd Shariff SM, Abu Bakar NS, Ramzuzzaman NS, Lim CK, Lim EYJ, et al. Polypharmacy and potentially inappropriate medications among hospitalized older adults with COVID-19 in Malaysian tertiary hospitals. J Pharm Policy Pract. 2023;16:2. doi: 10.1186/s40545-022-00504-1. - DOI - PMC - PubMed
    1. Smaje A, Weston-Clark M, Raj R, Orlu M, Davis D, Rawle M. Factors associated with medication adherence in older patients: a systematic review. Aging Med Milton NSW. 2018;1:254–266. doi: 10.1002/agm2.12045. - DOI - PMC - PubMed
    1. Gomes D, Placido AI, Mó R, Simões JL, Amaral O, Fernandes I, et al. Daily medication management and adherence in the polymedicated elderly: a cross-sectional study in Portugal. Int J Environ Res Public Health. 2019;17:200. doi: 10.3390/ijerph17010200. - DOI - PMC - PubMed
    1. Davies LE, Spiers G, Kingston A, Todd A, Adamson J, Hanratty B. Adverse outcomes of polypharmacy in older people: systematic review of reviews. J Am Med Dir Assoc. 2020;21:181–187. doi: 10.1016/j.jamda.2019.10.022. - DOI - PubMed

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