Impact of deprescribing intervention on potentially inappropriate medications and clinical outcomes among hospitalized older adults in Malaysia: a randomized controlled trial (REVMED RCT) protocol

Chang CT 1 , Teoh SL 2 , Cheah WK 3 , Lee PJ 4 , Azman MA 4 , Ling SH 5 Show all authors , Chuah ASC 5 , Sabki NH 6 , George D 6 , Oh HL 7 , Goh JY 7 , Lee SH 8 , Foong WK 9 , Lee JCY 10 , Chan HK 11 , Teoh LR 12 , Lim XJ 13 , Rajan P 13 , Lee SWH 2

Affiliations 

  • 1 Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia. davidcct.crc@gmail.com
  • 2 School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
  • 3 Clinical Research Centre, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
  • 4 Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
  • 5 Pharmacy Department, Hospital Seri Manjung, Ministry of Health Malaysia, Seri Manjung, Malaysia
  • 6 Pharmacy Department, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
  • 7 Pharmacy Department, Hospital Slim River, Ministry of Health Malaysia, Slim River, Malaysia
  • 8 Pharmacy Department, Hospital Kuala Kangsar, Ministry of Health Malaysia, Kuala Kangsar, Malaysia
  • 9 Pharmacy Department, Hospital Batu Gajah, Ministry of Health Malaysia, Batu Gajah, Malaysia
  • 10 Perak Pharmaceutical Services Division, Ministry of Health Malaysia, Tanjung Rambutan, Malaysia
  • 11 Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Malaysia
  • 12 Pharmacy Department, Hospital Sungai Siput, Ministry of Health Malaysia, Sungai Siput, Malaysia
  • 13 Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
J Pharm Policy Pract, 2023 Oct 03;16(1):113.
PMID: 37789376 DOI: 10.1186/s40545-023-00621-5

Abstract

BACKGROUND: Polypharmacy and the use of potentially inappropriate medications (PIMs) are prevalent among older patients admitted to hospitals, posing a heightened risk of adverse drug events. This trial aims to evaluate the effectiveness of a pharmacist-led deprescribing intervention in reducing medications, PIM and improving clinical outcomes, using the locally developed Malaysian Potentially Inappropriate Prescribing Screening tool in Older Adults (MALPIP).

METHODS: This is an 18-month cluster-randomized, open-label, parallel-arm controlled trial conducted at 14 public hospitals in the Perak state of Malaysia. Patients aged 60 and above, who have at least one medication and one comorbidity are eligible. A stratified-cluster randomization design is employed, with 7 hospitals assigned to the control arm and 7 hospitals assigned to the intervention arm. The MALPIP screening tool will be used in the intervention group to review the medications. If PIM is detected, the pharmacists will discuss with doctors and decide whether to stop or reduce the dose. The primary outcomes of this trial are the total number of medications and number of PIM. The secondary outcomes include fall, emergency department visits, readmissions, quality of life and mortality. Outcomes will be measured during enrolment, discharge, 6, 12, and 18 months.

DISCUSSION: This REVMED trial aims to test the hypothesis that a pharmacist-led deprescribing intervention initiated in the hospital will reduce the total number of medications and PIM 18 months after hospital discharge, reducing fall, emergency department visits, readmissions, mortality and lead to improvement in quality of life. Trial findings will quantify the clinical outcomes associated with reducing medications and PIM for hospitalized older adults with polypharmacy.

TRIAL REGISTRATION NUMBER: This trial was prospectively registered at clinicaltrials.gov (NCT05875623) on the 25th of May 2023. NCT05875623 Clinicaltrials.gov URL: NCT05875623 registered on 25th July 2023.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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