Medication Use and Quality of Life Among Older People

Sponsor
Odense University Hospital (Other)
Overall Status
Recruiting
CT.gov ID
NCT05123313
Collaborator
University of Southern Denmark (Other)
188
1
2
23.2
8.1

Study Details

Study Description

Brief Summary

This project will provide new evidence on how to optimize medication use among older people with limited life expectancy. This will be done by testing whether a patient-centered deprescribing intervention, focused on aligning medical treatment with patients' preferences, can improve quality of life among older people with limited life expectancy.

Condition or Disease Intervention/Treatment Phase
  • Behavioral: Deprescribing intervention
N/A

Detailed Description

In a pragmatic randomized controlled trial, this project will test whether a comprehensive and patient-centered deprescribing intervention can improve quality of life among older people with limited life expectancy. The intervention will comprise a series of consultations between the patient and general practitioner (GP) (at least three) to continuously adjust the patient's medication according to the patient's goals, needs, and preferences, thereby ensuring alignment with the patient's priorities. Thus, the purpose of this intervention is to initiate and facilitate a continued deprescribing process.

The process can be summarized in eight steps: During an initial consultation (1: Consultation 0), the GP assesses patient eligibility. If the patient would like to participate, a project nurse subsequently visits the patient at home (2: Home visit) for retrieval of informed consent as well as baseline measurements. After retrieval of informed consent, patients are randomized. Patients randomized to the control group continue with usual care (consultations with their GP when needed). Patients in the intervention group receive the intervention, comprising a series of consultations between the patient and GP (at least three). During the first intervention consultation (3: Consultation 1), the patient and GP discuss how the patient feels about their medical treatment, and the GP provides the patient with written material for the patient to prepare prior to the next consultation. The patients prepare (4: Preparation) by considering and verbalizing their goals of care and treatment preferences. Simultaneously, a clinical pharmacist examines the patient's medication list and provides suggestions to the GP on which drugs can be continued and deprescribed, respectively. During the next intervention consultation (5: Consultation 2), the patient and GP discuss the patient's preferences and initiate deprescribing initiatives aligned with the patient's priorities. During a new intervention consultation (6: Consultation 3), the patient and GP follow up on the changes initiated and initiate new deprescribing initiatives if such can be identified. If needed, subsequent intervention consultations (7: Consultation X) are planned until the patient and GP consider the patient's medical treatment optimal. A project nurse visits all patients (both patients randomized to the control and intervention group, respectively) at home 3 and 6 months after first home visit to retrieve follow-up measurements (8: Follow-ups). A project nurse retrieves medication lists at 3 months, 6 months, and 12 months.

Study Design

Study Type:
Interventional
Anticipated Enrollment :
188 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
Single (Outcomes Assessor)
Primary Purpose:
Health Services Research
Official Title:
Medication Use and Quality of Life Among Older People
Actual Study Start Date :
Oct 26, 2021
Anticipated Primary Completion Date :
Oct 1, 2022
Anticipated Study Completion Date :
Oct 1, 2023

Arms and Interventions

Arm Intervention/Treatment
No Intervention: Control group

The control group will not receive a series of consultations with their general practitioner. Controls will receive baseline measurements and follow-up measurements 3 months and 6 months following baseline measurements.

Experimental: Intervention group

The intervention will comprise a series of consultations between the patient and general practitioner (at least three), where the patient and general practitioner will continuously adjust the patient's medication according to the patient's goals, needs, and preferences. Interventions will receive baseline measurements and follow-up measurements 3 months and 6 months following baseline measurements.

Behavioral: Deprescribing intervention
The intervention is comprised of a minimum of three consultations with a general practitioner (GP), where adjustment of the patient's medication is made according to the patient's preference, goals and needs Consultation 1: Patient and GP discuss how the patient feels about their medical treatment, and the GP provides the patient with written material for the patient to prepare prior to the next consultation. Consultation 2: A clinical pharmacist have beforehand examined the patient's medication list and provided suggestions to the GP on which drugs can be deprescribed. The patient and GP discuss the patient's preferences and initiate deprescribing initiatives aligned with the patient's priorities. Consultation 3: Patient and GP follow up on the changes initiated and initiate new deprescribing initiatives if such can be identified. If needed, subsequent consultations (Consultation X) are planned until the patient and GP consider the patient's medical treatment optimal.

Outcome Measures

Primary Outcome Measures

  1. HEALTH-RELATED QUALITY OF LIFE [Baseline]

    Health-related quality of life will be measured using the Danish version of the Short Form 12 Health Survey Version 2 (SF-12v2).

  2. CHANGE FROM BASLINE HEALTH-RELATED QUALITY OF LIFE AT 3 MONTHS [3 months]

    Health-related quality of life will be measured using the Danish version of the Short Form 12 Health Survey Version 2 (SF-12v2).

  3. CHANGE FROM BASLINE HEALTH-RELATED QUALITY OF LIFE AT 6 MONTHS [6 months]

    Health-related quality of life will be measured using the Danish version of the Short Form 12 Health Survey Version 2 (SF-12v2).

  4. HEALTH-RELATED QUALITY OF LIFE (DEPRESSION) [Baseline]

    Health-related quality of life will be measured using the Danish version of the Depression List (DL).

  5. CHANGE FROM BASLINE HEALTH-RELATED QUALITY OF LIFE (DEPRESSION) AT 3 MONTHS [3 months]

    Health-related quality of life will be measured using the Danish version of the Depression List (DL).

  6. CHANGE FROM BASLINE HEALTH-RELATED QUALITY OF LIFE (DEPRESSION) AT 6 MONTHS [6 months]

    Health-related quality of life will be measured using the Danish version of the Depression List (DL).

  7. MORTALITY [3 months]

    Mortality will be assessed through the nationwide Danish Central Person Registry (CPR).

  8. MORTALITY [6 months]

    Mortality will be assessed through the nationwide Danish Central Person Registry (CPR).

  9. MORTALITY [12 months]

    Mortality will be assessed through the nationwide Danish Central Person Registry (CPR).

Secondary Outcome Measures

  1. COGNITIVE FUNCTION [Baseline, 3 months and 6 months]

    Cognitive function will be measured using the Danish version of the Mini-Mental State Examination Version 2 Standard Form (MMSE-2).

  2. FUNCTIONAL LEVEL [Baseline, 3 months and 6 months]

    Functional level will be measured using the Danish version of the Vulnerable Elders Survey 13 (VES-13).

  3. HAND-GRIP STRENGTH [Baseline, 3 months and 6 months]

    Hand-grip strength will be measured using a hand-grip dynamometer.

  4. NUMBER OF MEDICATION DISCONTINUED [3 months, 6 months and 12 months]

    Number of medications discontinued will be assessed through the medication lists.

  5. NUMBER OF MEDICATION CHANGES [3 months, 6 months and 12 months]

    Number of medication changes will be assessed through the medication lists.

  6. HOSPITAL ADMISSIONS [3 months, 6 months and 12 months]

    Hospital admissions will be assessed through the nationwide Danish National Patient Registry.

  7. HEALTH CARE COSTS [3 months, 6 months and 12 months]

    Health care costs will be assessed through nationwide Danish Health Care registries.

  8. SUCCESS RATE OF THE INTERVENTION [3 months, 6 months and 12 months]

    Success rate will be assessed through persisting discontinuations and changes of medications via the medication lists.

Eligibility Criteria

Criteria

Ages Eligible for Study:
80 Years and Older
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  • Aged ≥ 80 years

  • Take ≥ 8 different medications

  • Have a life expectancy of <2 years, estimated via the Surprise Question ("Would you be surprised if this patient died within 1-2 years?") by the general practitioner

  • have a Mini-Mental State Exam (MMSE) score of ≥18

  • Are able to provide informed consent

Exclusion Criteria:
  • Not able to communicate

  • Does not speak and understand Danish

Contacts and Locations

Locations

Site City State Country Postal Code
1 Odense University Hospital Odense Region Of Southern Denmark Denmark 5000

Sponsors and Collaborators

  • Odense University Hospital
  • University of Southern Denmark

Investigators

  • Principal Investigator: Anton Pottegård, Professor, University of Southern Denmark

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.
Responsible Party:
Carina Lundby, Postdoctoral Researcher, Odense University Hospital
ClinicalTrials.gov Identifier:
NCT05123313
Other Study ID Numbers:
  • ODIN-1
First Posted:
Nov 17, 2021
Last Update Posted:
Apr 20, 2022
Last Verified:
Apr 1, 2022
Individual Participant Data (IPD) Sharing Statement:
No
Plan to Share IPD:
No
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
No
Keywords provided by Carina Lundby, Postdoctoral Researcher, Odense University Hospital

Study Results

No Results Posted as of Apr 20, 2022