Garfinkel D, Zur-Gil S, Ben-Israel J. The war against polypharmacy: A new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people. Israel Medical Association Journal 2007;9:430-34
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/17642388
Full text article: https://www.ima.org.il/MedicineIMAJ/viewarticle.aspx?year=2007&month=06&page=430
| Methods | Study design: Prospective cohort study
Number of groups: Two groups |
| Participants | Number of participants: 190 enrolled
· Intervention deprescribing group: 119 enrolled · Control group: 71 enrolled Age: 81.2 ± 8.3 years Sex: 131 female, 59 male Participants with dementia: 178 participants (112 out of 119 participants in the intervention group, 66 out of 71 participants in the control group) Inclusion criteria: · All patients admitted to one of six nursing departments in a geriatric hospital Exclusion criteria: · Not described Concomitant medicines: 7.09 medicines per person Country: Israel Setting: Hospital – six nursing departments at the Shoham Geriatric Medical Center |
| Interventions | Medicines: Targeted as many medicines as possible
Withdrawal schedule: Not described Method to identify target: Patient-specific intervention Investigator-led intervention: Intervention by geriatrician who identified deprescribing targets and undertook the deprescribing process Tool to identify deprescribing targets: Good Palliation-Good Practice tool |
| Outcomes | Successful deprescribing
Death Admitted to acute care facility Medicine cost |
| Dates | Dates: Early 2004
Follow-up duration: One year |
| Funding sources | Not described |
| Notes |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High risk | This is not a randomized study design – it is a cohort study. |
| Allocation concealment (selection bias) | High risk | The allocationwas not concealed. |
| Blinding of participants and personnel (performance bias) | 5 out of 5 | This was an open study. |
| Blinding of outcome assessment (detection bias) | High risk | As above. |
| Incomplete outcome data (attrition bias) | Unclear risk | There are no drop-outs reportedthough it is unclear if this means that there was 100% follow-up. |
| Selective reporting (reporting bias) | 1 out of 5 | The statedoutcomes are reported onthough there was no prior protocol published. |
| Confounding (non-randomized) | 1 out of 5 | The groups werecomparable at baseline. |
| Other bias | Low risk | |
| Newcastle-Ottawa scale | ||
| Selection bias | Representativeness of the exposed cohort | Truly representative of the average older adult with multiple morbidities in full-time care. |
| Selection of the non-exposed cohort | The control group was drawn from the same community as the intervention cohort.
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| Ascertainment of exposure | Ascertainment of exposure was by securerecord. | |
| Demonstration that outcome of interest was not present at start of study | Yes. | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | The studycontrols for polypharmacy exposure. |
| Outcome bias | Assessment of outcome | Assessment of outcomes by record linkage.
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| Was follow-up long enough for outcomes to occur | Follow-upduration was probably long enough for outcomes to occur. | |
| Adequacy of follow-up of cohorts | Inadequate detail to assess the adequacy of follow-up of cohort participants. | |
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