Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study): protocol of a cluster randomised controlled trial

Hans Wouters; Elise H Quik; Froukje Boersma; Peder Nygård; Judith Bosman; Wendelien M Böttger; Hans Mulder; Jan-Gerard Maring; Linda Wijma-Vos; Tim Beerden; Jasperien van Doormaal; Maarten J Postma; Sytse U Zuidema; Katja Taxis

doi:10.1136/bmjopen-2014-006082

Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study): protocol of a cluster randomised controlled trial

Hans Wouters, Elise H Quik, Froukje Boersma, Peder Nygård, Judith Bosman, Wendelien M Böttger, Hans Mulder, Jan-Gerard Maring, Linda Wijma-Vos, Tim Beerden, Jasperien van Doormaal, Maarten J Postma, Sytse U Zuidema, Katja Taxis

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

INTRODUCTION: Nursing home residents often have a high number of comorbidities resulting in polypharmacy. Inappropriate prescribing is therefore likely to occur, which in turn is expected to worsen cognitive impairment, to increase the fall risk and to decrease residents' quality of life. The objective of the 'Discontinuing Inappropriate Medication in Nursing Home Residents' (DIM-NHR) study is to examine the efficacy and cost-effectiveness of the Multidisciplinary Multistep Medication Review (3MR) that is aimed at optimising prescribing and discontinuing inappropriate medication.

METHODS: A cluster randomised controlled trial will be conducted. Elderly care physicians and their wards (clusters) will be randomised. Data will be collected at baseline and 4 months after the 3MR has taken place. Six hundred nursing home residents will be recruited of whom more than half are expected to suffer from dementia. The 3MR will be based on consensus criteria and the relevant literature and will be performed by the patient's elderly care physician in collaboration with a pharmacist.

ANALYSIS: Primary outcomes-the difference in proportion of residents who successfully discontinued inappropriate medication between the intervention and control group at follow-up. Secondary outcomes-undertreatment, exposure to anticholinergic and sedative medicines, neuropsychiatric symptoms, cognitive function, falls, hospital admission, quality of life and cost-effectiveness.

ETHICS AND DISSEMINATION: Participant burden will be kept at a minimum. The elderly care physician will remain free to adjust medication when symptoms relapse or adverse events occur, rendering serious adverse events highly unlikely. Study findings will be published in peer-reviewed journals and a 3MR toolkit will be developed.

TRIAL REGISTRATION NUMBER: This study has been registered at http://www.ClinicalTrials.gov (trial registration number: NCT01876095).

Original language	English
Pages (from-to)	e006082
Journal	BMJ open [E]
Volume	4
Issue number	10
DOIs	https://doi.org/10.1136/bmjopen-2014-006082
Publication status	Published - 2014
Externally published	Yes

Keywords

Accidental Falls
Aged
Aged, 80 and over
Cholinergic Antagonists
Dementia
Disease Progression
Drug Utilization Review
Hospitalization
Humans
Hypnotics and Sedatives
Inappropriate Prescribing
Nursing Homes
Polypharmacy
Quality Improvement
Quality of Life
Journal Article
Multicenter Study
Pragmatic Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

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10.1136/bmjopen-2014-006082

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Wouters, H., Quik, E. H., Boersma, F., Nygård, P., Bosman, J., Böttger, W. M., Mulder, H., Maring, J.-G., Wijma-Vos, L., Beerden, T., van Doormaal, J., Postma, M. J., Zuidema, S. U., & Taxis, K. (2014). Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study): protocol of a cluster randomised controlled trial. BMJ open [E], 4(10), e006082. https://doi.org/10.1136/bmjopen-2014-006082

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title = "Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study): protocol of a cluster randomised controlled trial",

abstract = "INTRODUCTION: Nursing home residents often have a high number of comorbidities resulting in polypharmacy. Inappropriate prescribing is therefore likely to occur, which in turn is expected to worsen cognitive impairment, to increase the fall risk and to decrease residents' quality of life. The objective of the 'Discontinuing Inappropriate Medication in Nursing Home Residents' (DIM-NHR) study is to examine the efficacy and cost-effectiveness of the Multidisciplinary Multistep Medication Review (3MR) that is aimed at optimising prescribing and discontinuing inappropriate medication.METHODS: A cluster randomised controlled trial will be conducted. Elderly care physicians and their wards (clusters) will be randomised. Data will be collected at baseline and 4 months after the 3MR has taken place. Six hundred nursing home residents will be recruited of whom more than half are expected to suffer from dementia. The 3MR will be based on consensus criteria and the relevant literature and will be performed by the patient's elderly care physician in collaboration with a pharmacist.ANALYSIS: Primary outcomes-the difference in proportion of residents who successfully discontinued inappropriate medication between the intervention and control group at follow-up. Secondary outcomes-undertreatment, exposure to anticholinergic and sedative medicines, neuropsychiatric symptoms, cognitive function, falls, hospital admission, quality of life and cost-effectiveness.ETHICS AND DISSEMINATION: Participant burden will be kept at a minimum. The elderly care physician will remain free to adjust medication when symptoms relapse or adverse events occur, rendering serious adverse events highly unlikely. Study findings will be published in peer-reviewed journals and a 3MR toolkit will be developed.TRIAL REGISTRATION NUMBER: This study has been registered at http://www.ClinicalTrials.gov (trial registration number: NCT01876095).",

keywords = "Accidental Falls, Aged, Aged, 80 and over, Cholinergic Antagonists, Dementia, Disease Progression, Drug Utilization Review, Hospitalization, Humans, Hypnotics and Sedatives, Inappropriate Prescribing, Nursing Homes, Polypharmacy, Quality Improvement, Quality of Life, Journal Article, Multicenter Study, Pragmatic Clinical Trial, Randomized Controlled Trial, Research Support, Non-U.S. Gov't",

author = "Hans Wouters and Quik, {Elise H} and Froukje Boersma and Peder Nyg{\aa}rd and Judith Bosman and B{\"o}ttger, {Wendelien M} and Hans Mulder and Jan-Gerard Maring and Linda Wijma-Vos and Tim Beerden and {van Doormaal}, Jasperien and Postma, {Maarten J} and Zuidema, {Sytse U} and Katja Taxis",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.",

year = "2014",

doi = "10.1136/bmjopen-2014-006082",

language = "English",

volume = "4",

pages = "e006082",

journal = "BMJ open [E]",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "10",

}

Wouters, H, Quik, EH, Boersma, F, Nygård, P, Bosman, J, Böttger, WM, Mulder, H, Maring, J-G, Wijma-Vos, L, Beerden, T, van Doormaal, J, Postma, MJ, Zuidema, SU & Taxis, K 2014, 'Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study): protocol of a cluster randomised controlled trial', BMJ open [E], vol. 4, no. 10, pp. e006082. https://doi.org/10.1136/bmjopen-2014-006082

TY - JOUR

T1 - Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study)

T2 - protocol of a cluster randomised controlled trial

AU - Wouters, Hans

AU - Quik, Elise H

AU - Boersma, Froukje

AU - Nygård, Peder

AU - Bosman, Judith

AU - Böttger, Wendelien M

AU - Mulder, Hans

AU - Maring, Jan-Gerard

AU - Wijma-Vos, Linda

AU - Beerden, Tim

AU - van Doormaal, Jasperien

AU - Postma, Maarten J

AU - Zuidema, Sytse U

AU - Taxis, Katja

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2014

Y1 - 2014

N2 - INTRODUCTION: Nursing home residents often have a high number of comorbidities resulting in polypharmacy. Inappropriate prescribing is therefore likely to occur, which in turn is expected to worsen cognitive impairment, to increase the fall risk and to decrease residents' quality of life. The objective of the 'Discontinuing Inappropriate Medication in Nursing Home Residents' (DIM-NHR) study is to examine the efficacy and cost-effectiveness of the Multidisciplinary Multistep Medication Review (3MR) that is aimed at optimising prescribing and discontinuing inappropriate medication.METHODS: A cluster randomised controlled trial will be conducted. Elderly care physicians and their wards (clusters) will be randomised. Data will be collected at baseline and 4 months after the 3MR has taken place. Six hundred nursing home residents will be recruited of whom more than half are expected to suffer from dementia. The 3MR will be based on consensus criteria and the relevant literature and will be performed by the patient's elderly care physician in collaboration with a pharmacist.ANALYSIS: Primary outcomes-the difference in proportion of residents who successfully discontinued inappropriate medication between the intervention and control group at follow-up. Secondary outcomes-undertreatment, exposure to anticholinergic and sedative medicines, neuropsychiatric symptoms, cognitive function, falls, hospital admission, quality of life and cost-effectiveness.ETHICS AND DISSEMINATION: Participant burden will be kept at a minimum. The elderly care physician will remain free to adjust medication when symptoms relapse or adverse events occur, rendering serious adverse events highly unlikely. Study findings will be published in peer-reviewed journals and a 3MR toolkit will be developed.TRIAL REGISTRATION NUMBER: This study has been registered at http://www.ClinicalTrials.gov (trial registration number: NCT01876095).

AB - INTRODUCTION: Nursing home residents often have a high number of comorbidities resulting in polypharmacy. Inappropriate prescribing is therefore likely to occur, which in turn is expected to worsen cognitive impairment, to increase the fall risk and to decrease residents' quality of life. The objective of the 'Discontinuing Inappropriate Medication in Nursing Home Residents' (DIM-NHR) study is to examine the efficacy and cost-effectiveness of the Multidisciplinary Multistep Medication Review (3MR) that is aimed at optimising prescribing and discontinuing inappropriate medication.METHODS: A cluster randomised controlled trial will be conducted. Elderly care physicians and their wards (clusters) will be randomised. Data will be collected at baseline and 4 months after the 3MR has taken place. Six hundred nursing home residents will be recruited of whom more than half are expected to suffer from dementia. The 3MR will be based on consensus criteria and the relevant literature and will be performed by the patient's elderly care physician in collaboration with a pharmacist.ANALYSIS: Primary outcomes-the difference in proportion of residents who successfully discontinued inappropriate medication between the intervention and control group at follow-up. Secondary outcomes-undertreatment, exposure to anticholinergic and sedative medicines, neuropsychiatric symptoms, cognitive function, falls, hospital admission, quality of life and cost-effectiveness.ETHICS AND DISSEMINATION: Participant burden will be kept at a minimum. The elderly care physician will remain free to adjust medication when symptoms relapse or adverse events occur, rendering serious adverse events highly unlikely. Study findings will be published in peer-reviewed journals and a 3MR toolkit will be developed.TRIAL REGISTRATION NUMBER: This study has been registered at http://www.ClinicalTrials.gov (trial registration number: NCT01876095).

KW - Accidental Falls

KW - Aged

KW - Aged, 80 and over

KW - Cholinergic Antagonists

KW - Dementia

KW - Disease Progression

KW - Drug Utilization Review

KW - Hospitalization

KW - Humans

KW - Hypnotics and Sedatives

KW - Inappropriate Prescribing

KW - Nursing Homes

KW - Polypharmacy

KW - Quality Improvement

KW - Quality of Life

KW - Journal Article

KW - Multicenter Study

KW - Pragmatic Clinical Trial

KW - Randomized Controlled Trial

KW - Research Support, Non-U.S. Gov't

U2 - 10.1136/bmjopen-2014-006082

DO - 10.1136/bmjopen-2014-006082

M3 - Article

C2 - 25296655

SN - 2044-6055

VL - 4

SP - e006082

JO - BMJ open [E]

JF - BMJ open [E]

IS - 10

ER -

Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study): protocol of a cluster randomised controlled trial

Abstract

Keywords

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