A consumer-targeted, pharmacist-led, educational intervention to reduce inappropriate medication use in community older adults (D-PRESCRIBE trial): study protocol for a cluster randomized controlled trial

摘要: Medication safety for older persons represents an ongoing challenge. Inappropriate prescriptions – those with a high risk of evidence-based harm persist in up to 25 % seniors, and account significant proportion avoidable emergency department visits. This project is the sequel EMPOWER study, which novel consumer-targeted written knowledge transfer tool aimed at empowering adults act as drivers benzodiazepine de-prescription resulted 27 % reduction inappropriate use 6-month follow-up (number needed treat (NNT) = 4). Failure discontinue study was attributable re-emerging symptoms among participants, prescribing inertia, lack skills substituting alternate therapy physicians pharmacists. To maximize therapy, educational medication-risk initiatives should be tested that simultaneously include patients, The objective this trial to: 1) test beneficial effect new de-prescribing paradigm enlisting pharmacists both patients prescribers 2-pronged approach reduce prescriptions, compared usual care 2) evaluate transferability concept other classes prescriptions. We intend conduct 3-year pragmatic cluster randomized parallel-group controlled intervention reducing 4 from 2012 Beers criteria 450 community-dwelling polypharmacy. will benzodiazepines, sulfonylurea hypoglycemic agents, first generation antihistamines non-steroidal anti-inflammatory drugs. population recruited community pharmacies Quebec, Canada. developed based on systematic review evidence each medication. Participants experimental group receive program following randomization have their pharmacist send pharmaceutical opinion recommend followed year. control wait-listed 6 months. System change effectively medication seniors requires coordinated targeting physicians, patients. feasibility effectiveness tripartite de-prescribing. Registered via ClinicalTrials.gov 31 January 2014, identifier: NCT02053194 .