Aim 1 of the study is to identify the elements of a deprescribing intervention that address contextual factors specific to dialysis. Aim 2 of the study, described in this record, is to determine the feasibility of a deprescribing intervention tailored for older dialysis patients. Older adults receiving dialysis are often prescribed multiple medications. Some of these medications are used to treat symptoms, but they also can increase the chance of significant health problems. The purpose of this study is to identify if it is feasible to reduce the use of medications that have been identified as causing an increased risk for health problems.
Study Type
OBSERVATIONAL
Enrollment
48
The deprescribing program was implemented as a clinical quality improvement project for patients receiving dialysis. Patients taking specific potentially inappropriate medications (PIMs) were identified in the medical record. The PIMs of interest included gabapentinoids, clonidine, alpha blockers, muscle relaxants, and Z-drugs. If their nephrologist agreed to attempt deprescribing the PIM, either the nephrologist (Provider Only Communication) or a study team member (pharmacist or nurse, Provider/Patient Communication) would engage the patient in discussion about deprescribing. This discussion included patient education materials about the risk of the medication. If the patient agreed, they were provided taper instructions (if indicated) and were followed up at 1 month and 3 months. The patient was also invited to enroll in a study to be interviewed about the deprescribing decision and experience, and undergo brief assessment of geriatric problems at baseline and at 3 months.
Duke University
Durham, North Carolina, United States
Number of Deprescribing Events
Deprescribing events will be assessed for the Provider Only and Provider/Patient communication approaches. While this data is categorized into the two approaches, it is not intended for comparison.
Time frame: 3 months
Number of Potentially Eligible Subjects
The study team identified patients aged 55 and older with active prescriptions for specific potentially inappropriate medications (PIMs) (gabapentinoids, clonidine, alpha blockers, muscle relaxants, and Z-drugs) from the medical record and met criteria for deprescribing.
Time frame: Baseline
Proportion of Clinicians Who Found the Deprescribing Program Met Their Approval
This is an assessment of provider acceptability, defined as those who answered "agree" or "completely agree" to the Likert item: The deprescribing program meets my approval.
Time frame: Baseline
Proportion of Clinicians Who Found the Deprescribing Program Fit Their Routine
This is an assessment of provider acceptability. The outcome was defined as those who answered "agree" or "completely agree" to the Likert item: The deprescribing program seems fitting with my clinical routine.
Time frame: Baseline
Proportion of Clinicians Who Found the Deprescribing Program Seemed Doable
This is an assessment of provider acceptability. The outcome was defined as those who answered "agree" or "completely agree" to the Likert item: The deprescribing program seems doable.
Time frame: Baseline
Number of Adverse Drug Withdrawal Events
Symptoms develop related to cutting back or stopping a medication. This was identified by chart review and/or if reported by patient to study team.
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Time frame: 3 months
Change in Functional Assessment
Enrolled participants completed the Older Americans Resources and Services (OARS) functional assessment which assesses instrumental and basic activities of daily living (ADLs). The instrument scores range from 0-28, with higher scores indicating better ability to do ADLs.
Time frame: Baseline, 3 months
Change in Fall Risk Questionnaire
Enrolled participants completed the CDC STEADI Fall Risk instrument. The instrument scores range from 0-14, with higher scores indicating a greater risk of falls.
Time frame: Baseline, 3 months
Change in Patient Health Questionnaire-9 (PHQ9)
Enrolled participants completed the PHQ9 instrument which assesses for depression. The instrument scores range from 0-27, with higher scores indicating a greater depression severity.
Time frame: Baseline, 3 months
Change in Cognitive Change Index
Enrolled participants completed the Cognitive Change Index instrument which assesses for cognition. The instrument scores range from 0-100, with higher scores indicating a greater likelihood of cognitive impairment.
Time frame: Baseline, 3 months
Sustainability, as Measured by the Proportion of Patients Who Remained Off PIM at a Lower Dose
Among those who deprescribed, the study team followed up by phone to inquire if they were still off the PIM and/or taking a lower dose than before
Time frame: 3 months
Practicality, as Measured by Average Time (in Days) Spent Awaiting Provider Response to Deprescribing Recommendation
The investigators will compare practicality of Provider-only Communication and Provider/Patient Communication because the Provider/Patient Communication involved additional staff outside of the dialysis clinic and such staff would not be guaranteed in real-world application of this intervention.
Time frame: Baseline
Practicality, as Measured by the Average Time (in Days) to Initial Patient Communication
The investigators will assess practicality in the QIP - Provider / Patient Communication format.
Time frame: Baseline
Practicality, as Measured by the Average Number of Attempts to Reach the Patient
The investigators will assess practicality in the QIP - Provider / Patient Communication format.
Time frame: Baseline
Practicality, as Measured by the Average Number of Conversations
The investigators will assess practicality in the QIP - Provider / Patient Communication format.
Time frame: Baseline
Practicality, as Measured by the Average Length of Conversations With Patients About Deprescribing
The investigators will assess practicality in the QIP - Provider / Patient Communication format.
Time frame: Baseline