Priorities Aligned Deprescribing for Persons Living With Dementia and Their Caregiver
Study Details
Study Description
Brief Summary
The purpose of this study is to compare patient priorities care (PPC) and usual care (UC) patients to identify differences in post-encounter medication changes, treatment burden (TBQ), and shared decision making in Older Patient Assessment of Chronic Illness Care (OPACIC), to understand PPC participant's sense-making and communication approaches related to deprescribing decisions in relation to the identified health priorities and to identify and categorize adverse drug withdrawal events (ADWEs)
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: PPC
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Behavioral: PPC
Participants will have an encounter with a facilitator who will identify priorities (outcome goals and care preferences) from the dyads and transmits them in the electronic health records (EHR), and a follow-up encounter with their usual geriatric care provider to decide upon changes in their care that align with the identified priorities.
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| Active Comparator: Usual Care
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Behavioral: Usual care
Participants will have a geriatric clinic visit with a geriatrician that acts as their primary care provider (PCP) , in which the dyads will be encouraged by an unblinded study coordinator to ask about reducing medication burden.
|
Outcome Measures
Primary Outcome Measures
- Number of medication changes [Baseline, 3 month]
- Type of medication changes [Baseline, 3 month]
- Change in patient reported treatment burden as assessed by the Treatment Burden Questionnaire (TBQ) [Baseline, 3 month]
This is a 15 item questionnaire and each is scored from 0(not a problem) to 10(big problem) for a maximum score of 150, higher number indicating more burden
- Number, likelihood, and severity of adverse drug reactions (ADRs) as assessed by the Naranjo scale [3 months]
Naranjo scale is a 10 item questionnaire.Total scores range from -4 to +13; the reaction is considered definite if the score is 9 or higher, probable if 5 to 8, possible if 1 to 4, and doubtful if 0 or less.
- Number, likelihood, and severity of adverse drug withdrawal events (ADWEs) as assessed by the Naranjo scale [3 months]
Naranjo scale is a 10 item questionnaire.Total scores range from -4 to +13; the reaction is considered definite if the score is 9 or higher, probable if 5 to 8, possible if 1 to 4, and doubtful if 0 or less.
Secondary Outcome Measures
- Patient perceived chronic disease care as assessed by the Older Patient Assessment of Chronic Illness Care (OPACIC) score [Baseline, 3 months]
This is a 10 item questionnaire and each is scored from 1(almost never) to 5(almost always),for a maximum score of 50 ,higher scores indicate better perceived chronic disease care
Eligibility Criteria
Criteria
Inclusion Criteria:
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Dementia listed as an active problem in the medical record, including Alzheimer's disease, vascular dementia, frontotemporal dementia, Parkinson's dementia, Lewy body disease.
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The functional assessment staging tool (FAST) score of 5 or lower (This will be established by the patient's clinician).
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2 or more additional chronic conditions
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Takes 5 or more regular medications and
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A caregiver present during visits. Caregivers may include family members or unrelated caregivers and will be identified through chart review and confirmed by clinician, patient, and surrogate decision maker if necessary. Identified caregivers must be involved in decisions and care of People living with dementia (PLWD) and routinely attend clinic visits with patient
Exclusion Criteria:
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FAST score of 6 or more (This will be established by the patient's clinician).
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Significant hearing, vision, or advanced cognitive impairment that limits ability to participate in PPC encounters,
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Caregiver is unwilling or able to participate in visits, or
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Deemed ineligible by their Primary care physician (PCP)
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | The University of Texas Health Science Center at Houston | Houston | Texas | United States | 77030 |
Sponsors and Collaborators
- The University of Texas Health Science Center, Houston
Investigators
- Principal Investigator: Aanand D Naik, MD, The University of Texas Health Science Center, Houston
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- HSC-SPH-22-0639