Rationalisation of Polypharmacy in the Elderly by the RASP Instrument

Overview

The aim of this study is to determine whether a clinical pharmacist using the RASP list (RASP = Rationalisation of home medication by an adjusted STOPP-list in older patients; STOPP = Screening Tool of Older Persons' potentially inappropriate Prescriptions) can optimise the drug use in elderly inpatients.

Full Title of Study: “Rationalisation of Polypharmacy in the Elderly by the RASP Instrument (Rationalisation of Home Medication by an Adjusted STOPP-list in Older Patients): a Prospective, Clinical Trial.”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Non-Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Health Services Research
    • Masking: Single (Care Provider)
  • Study Primary Completion Date: August 2012

Detailed Description

Older persons take on average multiple drugs. As people age, there is an apparent increase in pharmacodynamic sensitivity to different making the patient more prone to experience side effects. Alterations in body composition and concomitant changes in pharmacokinetic parameters can also result in a higher risk for adverse drug events. All these factors make the older person, notwithstanding the heterogeneity of this population, more vulnerable for the negative consequences of polypharmacy. Polypharmacy is a cause of negative clinical outcomes but it still remains unclear which intervention or set of interventions should be used to optimize the prescription of pharmacotherapy in the elderly patient. Therefore, the investigators developed the RASP (RASP = Rationalisation of home medication by an adjusted STOPP-list in older patients; STOPP = Screening Tool of Older Persons' potentially inappropriate Prescriptions), a list as tool to reduce polypharmacy adapted to Belgian national prescribing tendencies within geriatric wards. Content and reliability of the RASP have been validated and the investigators aim to further study the impact of the systematic implementation of this RASP on geriatric wards in a prospective cluster randomized controlled trial.

Interventions

  • Other: Pharmaceutical care plan, mostly based on the RASP
    • Drug use of subjects enrolled in this arm will be systematically evaluated by a clinical pharmacist, using the RASP list. Potentially inappropriate drug use will be pointed out to the treating physician. The pharmaceutical advice is not limited to the RASP list. Any actual change in drug prescription will be decided by the treating physician based upon comprehensive medical evaluations in each individual patient.

Arms, Groups and Cohorts

  • Active Comparator: RASP
  • No Intervention: Control group
    • Subjects enrolled in this arm will undergo usual medical and pharmaceutical care with registration of drug use at admission and discharge without interference of RASP or clinical pharmacist.

Clinical Trial Outcome Measures

Primary Measures

  • Number of actually stopped or adjusted drugs
    • Time Frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days.
    • At hospital discharge the number of stopped or adjusted drugs will be determined. This variable will be compared between the two arms.

Secondary Measures

  • Number of potentially inappropriate drug prescriptions as defined by the RASP.
    • Time Frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days.
  • Actual drug use
    • Time Frame: Measured on 30 and 90 days post-discharge.
  • Number and category of drugs adjusted on recommendations of the clinical pharmacist independent of RASP
    • Time Frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days.
  • Mortality
    • Time Frame: Measured during hospitalisation, an expected average of 14 days and within 90 days after discharge.
  • Number of falls
    • Time Frame: Measured during hospitalisation, an expected average of 14 days and within 90 days after discharge
  • Quality of Life (EQ-5D-3L)
    • Time Frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days.
  • Length of stay
    • Time Frame: Determined at discharge, on average after 14 days
  • Rehospitalisation
    • Time Frame: Within 90 days post-discharge.
  • Incidence of delirium
    • Time Frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days
  • Number of falls post-discharge
    • Time Frame: Within 90 days post-discharge

Participating in This Clinical Trial

Inclusion Criteria

  • Signed informed consent by the patient or a caregiver if the patient is incompetent to sign – Consecutive inclusion of all newly admitted patients to the wards coming from home or the emergency room department Exclusion Criteria:

  • Patients not admitted to the hospital from home or a nursing home – Patients unable to communicate in Dutch – Patients admitted for palliative care – Patients who do not take any drugs at admission

Gender Eligibility: All

Minimum Age: 65 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Universitaire Ziekenhuizen KU Leuven
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Lorenz Van der Linden, PharmD, Principal Investigator, Universitaire Ziekenhuizen KU Leuven

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