Topics

MedSafer E-care: an Automated Deprescribing Solution (E-CARE Study)

2019-09-18 03:27:53 | BioPortfolio

Summary

The investigators will link MedSafer (a Canadian-made electronic tool) with a large multi-national electronic medical record (EMR), MED e-care, through an existing application programming interface (API) that provides clinicians with electronic, patient-specific deprescribing reports. They will implement a highly scalable deprescribing intervention in a staged and controlled fashion across five Canadian Aged Care Facilities. The investigators aim to test the feasibility of the API for the purposes of generating real time automated deprescribing reports, displayed to the user in the EMR.

Description

MedSafer is a Canadian-made electronic tool that automates deprescribing and generates individualized, prioritized deprescribing opportunities for older adults based on existing evidence from algorithms such as the Beer's criteria and STOPP/START in order to stop potentially inappropriate medications. Its clinical content has been in place for over a year in a Canadian Institutes for Health Research funded study and has been tested on over 5000 hospitalized patients. Software output has been analyzed and validated by Canadian experts in internal medicine, geriatrics, palliative care, nursing, and pharmacy.

In the previous study funded by the Canadian Institutes for Health Research (expected total recruitment: 6000), while deprescribing reports were generated automatically, data still had to be entered manually, by trained research assistants. For this study, the next stage of development involved creating an API that could accept medical conditions in the format of ICD10 codes and medications as DINs.

"MedSafer e-Care" addresses the needs of patients and caretakers by facilitating safe deprescribing. Deprescribing is time consuming, complex, and not all caretakers (clinicians) are trained with the expert knowledge required to cross reference multiple medical conditions with often 10 or more medications. "MED e-care" is an EMR (electronic medical record) that contains patient medical conditions and medications stored as international disease classification codes (ICD10) and drug identification numbers (DIN). The MedSafer team has designed an API that cross-references ICD10 codes and DINs against existing evidence-based algorithms for safe deprescribing. The API has been tested on a variety of medical conditions and medications contained within the MedSafer rule set. This process can overcome barriers to stopping medications including caretaker time constraints and knowledge gaps.

Data packets are processed by the MedSafer API and deprescribing reports are returned to MED e-care and displayed to the user on the EMR interface. Reports will be available to caretakers (nurses, physicians and pharmacists) who can choose to stop or taper medications within the EMR. Opportunities are prioritized based on potential for harm and ease of discontinuation, and factor in a measure of patient frailty and life expectancy. When necessary, instructions for tapering medications are provided. Links to patient educational brochures are included and can be printed for the patient and family detailing harmful medications and deprescribing rationale. MED e-care has already entered negotiations with the nursing home group OMNI Health Care to recruit at least five and up to 18 of the 18 care sites from within the OMNI group of homes across Ontario.

The estimated duration of the study is 12 months. Deployment will approximate a Stepped Wedge Cluster Randomized Trial Design (calculations performed with steppedwedge function in Stata v. 15). To accomplish this, at least 10 unique patients would need to be enrolles per ACF every 2 months following a 3-month baseline period (minimum total 300 patients).

The 5 OMNI ACFs will be grouped in 3 clusters. During the control phase, the MedSafer API will not be accessible to the caretakers at the ACF. This serves to obtain baseline deprescribing levels for each ACF. When the first cluster completes its baseline phase, the MedSafer API feature will become accessible in MED e-care for the physicians, pharmacists and nurses. Staff at the ACFs will receive a communiqué before entering the intervention phase as well as a brief training on how to access this feature in the EMR. Following a 3 month intervention period, the 2nd cluster will switch from its baseline phase to intervention. The last cluster will enter the intervention phase 3 months after that. Once in the intervention phase, users will receive quarterly deprescribing reports for their patients. MED e-care will selectively allow access to the MedSafer feature for each site when it is their turn to enter the intervention phase.

Cluster 1: 3 months control + 9 months intervention

Cluster 2: 6 months control + 6 months intervention

Cluster 3: 9 months control + 3 months intervention

During the control phase, residents at the 5 nursing homes or their proxy will be contacted by a trained research assistant who will ask them to participate in the study. Their participation will consist of a survey regarding their attitude towards deprescribing.

During the intervention phase, staff at the nursing homes (nurse, pharmacist, physician) will be asked to distribute educational brochures regarding medications to patients/proxies, as applicable to the medications the patient is taking.

During the intervention phase, this feature will provide users with individualized and prioritized deprescribing opportunities: a) identifying the medication, b) explaining why that medication is potentially inappropriate and c) providing instructions on how to safely stop/taper the medication. The user will review these opportunities and appropriate candidate medications for deprescribing can then be tapered or stopped directly in the EMR.

Structured feedback about MedSafer deprescribing opportunities is important and imperative to optimize success and sustainability of any deprescribing intervention. Working with the user, through rapid cycle interventions, the investigators will curate an output that minimizes alert fatigue and is acceptable to stakeholders (caretakers/clinicians). Users of the MedSafer feature will include physicians, pharmacists and nurses, including nurse practitioners, at the 5 OMNI long-term care facilities.

Study Design

Conditions

Polypharmacy

Intervention

Electronic decision support for deprescribing (MedSafer tool)

Status

Not yet recruiting

Source

McGill University Health Centre/Research Institute of the McGill University Health Centre

Results (where available)

View Results

Links

Published on BioPortfolio: 2019-09-18T03:27:53-0400

Clinical Trials [1692 Associated Clinical Trials listed on BioPortfolio]

Electronic Decision Support for Intervention in Poorly Controlled Type 2 Diabetes

To determine the impact of an electronic decision support tool on physician decision making and patient outcomes for the treatment of poorly controlled diabetes mellitus. Primary endpoint ...

Electronic Deprescribing Tool for the Prevention of PIP

This study is a cluster randomized control trial aimed to measure the effectiveness of an educational knowledge transfer intervention to prescribers on the discontinuation of two targeted ...

Deprescribing of Symptomatic Medications in Rehabilitative or Subacute Care Patients

Deprescribing is a systematic method of withdrawing potentially inappropriate or unnecessary medications and is warranted in the elderly due to the high prevalence of polypharmacy. In part...

Deprescribing: a Portrait and Out-comes of the Reduction of Polypharmacy in Portugal

This study protocol comprises three phases. The first two phases will be nationwide and aim to evaluate the prevalence and patterns of polypharmacy and assess the barriers and facilitators...

Opportunities and Limits to Deprescribing in Nursing Homes:Quality Circle Deprescribing Module

Older people residing in nursing homes (NH) are frequently polymedicated and often prescribed potentially inappropriate medications. Deprescribing has been proposed as a way to reduce the ...

PubMed Articles [12537 Associated PubMed Articles listed on BioPortfolio]

Advancing the Science of Deprescribing: A Novel Comprehensive Conceptual Framework.

Polypharmacy is common in older adults and associated with inappropriate medication use, adverse drug events, medication nonadherence, higher costs, and increased mortality compared with those without...

Estimating the impact of deploying an electronic clinical decision support tool as part of a national practice improvement project.

Estimate the impact on clinical practice of using a mobile device-based electronic clinical decision support (mECDS) tool within a national standardization project.

Understanding implementation and usefulness of electronic clinical decision support (eCDS) for melanoma in English primary care: a qualitative investigation.

Timely diagnosis of the serious skin cancer melanoma can improve patient outcomes. Clinical guidelines suggest that GPs use checklists, such as the 7-point checklist (7PCL), to assess pigmented lesion...

Physician Perspectives on Deprescribing Cardiovascular Medications for Older Adults.

Guideline-based management of cardiovascular disease often involves prescribing multiple medications, which contributes to polypharmacy and risk for adverse drug events in older adults. Deprescribing ...

An Approach for Data Mining of Electronic Health Record Data for Suicide Risk Management: Database Analysis for Clinical Decision Support.

In an electronic health context, combining traditional structured clinical assessment methods and routine electronic health-based data capture may be a reliable method to build a dynamic clinical deci...

Medical and Biotech [MESH] Definitions

Mathematical or statistical procedures used as aids in making a decision. They are frequently used in medical decision-making.

Computer-based information systems used to integrate clinical and patient information and provide support for decision-making in patient care.

A graphic device used in decision analysis, series of decision options are represented as branches (hierarchical).

Controlled operation of an apparatus, process, or system by mechanical or electronic devices that take the place of human organs of observation, effort, and decision. (From Webster's Collegiate Dictionary, 1993)

Professionals trained in providing information, guidance, and recommendations to individual clients or families to support their decision making and development of coping skills.

More From BioPortfolio on "MedSafer E-care: an Automated Deprescribing Solution (E-CARE Study)"

Quick Search

Relevant Topics

Geriatrics
Geriatrics is the branch of medicine that is concerned with the diagnosis and management of diseases and disorders that occur in old age. A specialty is required because of the frequency of co-morbidities in these patients and the reduced strength of the...

Palliative Care
Palliative care is the active holistic care of patients with advanced progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of the ...


Searches Linking to this Trial