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The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial
IMPORTANCE: Scalable deprescribing interventions may reduce polypharmacy and the use of potentially inappropriate medications (PIMs); however, few studies have been large enough to evaluate the impact that deprescribing may have on adverse drug events (ADEs). OBJECTIVE: To evaluate the effect of an...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767487/ https://www.ncbi.nlm.nih.gov/pubmed/35040926 http://dx.doi.org/10.1001/jamainternmed.2021.7429 |
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author | McDonald, Emily G. Wu, Peter E. Rashidi, Babak Wilson, Marnie Goodwin Bortolussi-Courval, Émilie Atique, Anika Battu, Kiran Bonnici, Andre Elsayed, Sarah Wilson, Allison Goodwin Papillon-Ferland, Louise Pilote, Louise Porter, Sandra Murphy, Johanna Ross, Sydney B. Shiu, Jennifer Tamblyn, Robyn Whitty, Rachel Xu, Jieqing Fabreau, Gabriel Haddad, Taleen Palepu, Anita Khan, Nadia McAlister, Finlay A. Downar, James Huang, Allen R. MacMillan, Thomas E. Cavalcanti, Rodrigo B. Lee, Todd C. |
author_facet | McDonald, Emily G. Wu, Peter E. Rashidi, Babak Wilson, Marnie Goodwin Bortolussi-Courval, Émilie Atique, Anika Battu, Kiran Bonnici, Andre Elsayed, Sarah Wilson, Allison Goodwin Papillon-Ferland, Louise Pilote, Louise Porter, Sandra Murphy, Johanna Ross, Sydney B. Shiu, Jennifer Tamblyn, Robyn Whitty, Rachel Xu, Jieqing Fabreau, Gabriel Haddad, Taleen Palepu, Anita Khan, Nadia McAlister, Finlay A. Downar, James Huang, Allen R. MacMillan, Thomas E. Cavalcanti, Rodrigo B. Lee, Todd C. |
author_sort | McDonald, Emily G. |
collection | PubMed |
description | IMPORTANCE: Scalable deprescribing interventions may reduce polypharmacy and the use of potentially inappropriate medications (PIMs); however, few studies have been large enough to evaluate the impact that deprescribing may have on adverse drug events (ADEs). OBJECTIVE: To evaluate the effect of an electronic deprescribing decision support tool on ADEs after hospital discharge among older adults with polypharmacy. DESIGN, SETTING, AND PARTICIPANTS: This was a cluster randomized clinical trial of older (≥65 years) hospitalized patients with an expected survival of more than 3 months who were admitted to 1 of 11 acute care hospitals in Canada from August 22, 2017, to January 13, 2020. At admission, participants were taking 5 or more medications per day. Data analyses were performed from January 3, 2021, to September 23, 2021. INTERVENTIONS: Personalized reports of deprescribing opportunities generated by MedSafer software to address usual home medications and measures of prognosis and frailty. Deprescribing reports provided to the treating team were compared with usual care (medication reconciliation). MAIN OUTCOMES AND MEASURES: The primary outcome was a reduction of ADEs within the first 30 days postdischarge (including adverse drug withdrawal events) captured through structured telephone surveys and adjudicated blinded to intervention status. Secondary outcomes were the proportion of patients with 1 or more PIMs deprescribed at discharge and the proportion of patients with an adverse drug withdrawal event (ADWE). RESULTS: A total of 5698 participants (median [range] age, 78 [72-85] years; 2858 [50.2%] women; race and ethnicity data were not collected) were enrolled in 3 clusters and were adjudicated for the primary outcome (control, 3204; intervention, 2494). Despite cluster randomization, there were group imbalances, eg, the participants in the intervention arm were older and had more PIMS prescribed at baseline. After hospital discharge, 4989 (87.6%) participants completed an ADE interview. There was no significant difference in ADEs within 30 days of discharge (138 [5.0%] of 2742 control vs 111 [4.9%] of 2247 intervention participants; adjusted risk difference [aRD] −0.8%; 95% CI, −2.9% to 1.3%). Deprescribing increased from 795 (29.8%) of 2667 control to 1249 (55.4%) of 2256 intervention participants [aRD, 22.2%; 95% CI, 16.9% to 27.4%]. There was no difference in ADWEs between groups. Several post hoc sensitivity analyses, including the use of a nonparametric test to address the low cluster number, group imbalances, and potential biases, did not alter study conclusions. CONCLUSIONS AND RELEVANCE: This cluster randomized clinical trial showed that providing deprescribing clinical decision support during acute hospitalization had no demonstrable impact on ADEs, although the intervention was safe and led to improvements in deprescribing. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03272607 |
format | Online Article Text |
id | pubmed-8767487 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-87674872022-02-04 The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial McDonald, Emily G. Wu, Peter E. Rashidi, Babak Wilson, Marnie Goodwin Bortolussi-Courval, Émilie Atique, Anika Battu, Kiran Bonnici, Andre Elsayed, Sarah Wilson, Allison Goodwin Papillon-Ferland, Louise Pilote, Louise Porter, Sandra Murphy, Johanna Ross, Sydney B. Shiu, Jennifer Tamblyn, Robyn Whitty, Rachel Xu, Jieqing Fabreau, Gabriel Haddad, Taleen Palepu, Anita Khan, Nadia McAlister, Finlay A. Downar, James Huang, Allen R. MacMillan, Thomas E. Cavalcanti, Rodrigo B. Lee, Todd C. JAMA Intern Med Original Investigation IMPORTANCE: Scalable deprescribing interventions may reduce polypharmacy and the use of potentially inappropriate medications (PIMs); however, few studies have been large enough to evaluate the impact that deprescribing may have on adverse drug events (ADEs). OBJECTIVE: To evaluate the effect of an electronic deprescribing decision support tool on ADEs after hospital discharge among older adults with polypharmacy. DESIGN, SETTING, AND PARTICIPANTS: This was a cluster randomized clinical trial of older (≥65 years) hospitalized patients with an expected survival of more than 3 months who were admitted to 1 of 11 acute care hospitals in Canada from August 22, 2017, to January 13, 2020. At admission, participants were taking 5 or more medications per day. Data analyses were performed from January 3, 2021, to September 23, 2021. INTERVENTIONS: Personalized reports of deprescribing opportunities generated by MedSafer software to address usual home medications and measures of prognosis and frailty. Deprescribing reports provided to the treating team were compared with usual care (medication reconciliation). MAIN OUTCOMES AND MEASURES: The primary outcome was a reduction of ADEs within the first 30 days postdischarge (including adverse drug withdrawal events) captured through structured telephone surveys and adjudicated blinded to intervention status. Secondary outcomes were the proportion of patients with 1 or more PIMs deprescribed at discharge and the proportion of patients with an adverse drug withdrawal event (ADWE). RESULTS: A total of 5698 participants (median [range] age, 78 [72-85] years; 2858 [50.2%] women; race and ethnicity data were not collected) were enrolled in 3 clusters and were adjudicated for the primary outcome (control, 3204; intervention, 2494). Despite cluster randomization, there were group imbalances, eg, the participants in the intervention arm were older and had more PIMS prescribed at baseline. After hospital discharge, 4989 (87.6%) participants completed an ADE interview. There was no significant difference in ADEs within 30 days of discharge (138 [5.0%] of 2742 control vs 111 [4.9%] of 2247 intervention participants; adjusted risk difference [aRD] −0.8%; 95% CI, −2.9% to 1.3%). Deprescribing increased from 795 (29.8%) of 2667 control to 1249 (55.4%) of 2256 intervention participants [aRD, 22.2%; 95% CI, 16.9% to 27.4%]. There was no difference in ADWEs between groups. Several post hoc sensitivity analyses, including the use of a nonparametric test to address the low cluster number, group imbalances, and potential biases, did not alter study conclusions. CONCLUSIONS AND RELEVANCE: This cluster randomized clinical trial showed that providing deprescribing clinical decision support during acute hospitalization had no demonstrable impact on ADEs, although the intervention was safe and led to improvements in deprescribing. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03272607 American Medical Association 2022-01-18 2022-03 /pmc/articles/PMC8767487/ /pubmed/35040926 http://dx.doi.org/10.1001/jamainternmed.2021.7429 Text en Copyright 2022 McDonald EG et al. JAMA Internal Medicine. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation McDonald, Emily G. Wu, Peter E. Rashidi, Babak Wilson, Marnie Goodwin Bortolussi-Courval, Émilie Atique, Anika Battu, Kiran Bonnici, Andre Elsayed, Sarah Wilson, Allison Goodwin Papillon-Ferland, Louise Pilote, Louise Porter, Sandra Murphy, Johanna Ross, Sydney B. Shiu, Jennifer Tamblyn, Robyn Whitty, Rachel Xu, Jieqing Fabreau, Gabriel Haddad, Taleen Palepu, Anita Khan, Nadia McAlister, Finlay A. Downar, James Huang, Allen R. MacMillan, Thomas E. Cavalcanti, Rodrigo B. Lee, Todd C. The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial |
title | The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial |
title_full | The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial |
title_fullStr | The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial |
title_full_unstemmed | The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial |
title_short | The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial |
title_sort | medsafer study—electronic decision support for deprescribing in hospitalized older adults: a cluster randomized clinical trial |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767487/ https://www.ncbi.nlm.nih.gov/pubmed/35040926 http://dx.doi.org/10.1001/jamainternmed.2021.7429 |
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