Ailabouni, N., Mangin, D. & Nishtala, P.S. DEFEAT-polypharmacy: deprescribing anticholinergic and sedative medicines feasibility trial in residential aged care facilities. Int J Clin Pharm 2019 41, 167–178
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/30659492
Full text article: https://link.springer.com/article/10.1007%2Fs11096-019-00784-9
| Methods | Study design: Non-randomized before/after
Number of groups: 1 |
| Participants | Number of participants: 46
Age: Not reported Female: 34 (73%) Participants with dementia: Unclear Inclusion criteria: · ≥65 years · Prescribed ≥1 anticholinergic or sedating medicine · Drug Burden Index ≥0.5 Exclusion criteria: · Limited life expectancy · Receiving palliative care · Admitted for hospice Country: New Zealand Setting: 3 residential aged care facilities |
| Interventions | Medicine: benzodiazepine, typical antipsychotic, atypical antipsychotic, antidepressant, sedative medicines
Intervention: pharmacist-led medication review with GPs including development of medication management plans Withdrawal schedule: Individualized. If a medicine was successfully ceased, patient was reviewed for 2 weeks until dose of next target medicine was reduced until ceased |
| Outcomes | Change in Drug Burden Index
Self-reported quality of life (EQ-5D-5L) Cognition (InterRAI-LTCF) Self-reported psychotropic adverse effects (UKU-SERS) Number of falls in previous 6 months Change in mean number of prescribed medicines Proportion of recommendations implemented by GP Geriatric depression |
| Dates | Dates: Not reported
Follow-up duration: 6 months |
| Funding sources | Lotteries Health Research |
| Notes | Does not report age-to ask authors (also dates)
According to protocol: “Recruitment is set to start on 01/06/2016. Follow-up is set to continue until 01/07/2017. The planned end date for data collection is 01/07/2017” |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | Low risk | Before-and-after study design |
| Allocation concealment (selection bias) | High risk | Single arm study |
| Blinding of participants and personnel (performance bias) | High risk | Participant, the pharmacists and GPs carrying out the intervention were not blinded |
| Blinding of outcome assessment (detection bias) | High risk | Single group, outcome assessments not blinded |
| Incomplete outcome data (attrition bias) | Low risk | 3 withdrawals, 2 due to death before enrolment.
Intention-to-treat analysis presented |
| Selective reporting (reporting bias) | Low risk | Published protocol and clinical trial registration
|
| Confounding (non-randomized) | High risk | No control group, confounders not described |
| Other bias | Low risk | |
| Selection bias | Representativeness of the exposed cohort | Truly representative of older RACF residents |
| Selection of the non-exposed cohort | No concurrent control group | |
| Ascertainment of exposure | Ascertainment of exposure through secure record | |
| Demonstration that outcome of interest was not present at start of study | Demonstrated the outcome of interest was not present at the start of the study. | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | No concurrent control group |
| Outcome bias | Assessment of outcome | Assessment of outcome by record linkage |
| Was follow-up long enough for outcomes to occur | Follow-up was probably sufficient for the outcomes | |
| Adequacy of follow-up of cohorts | Small number lost to follow-up, unlikely to introduce bias | |
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