NCT Number: NCT02604056
Two arm, pragmatic, cluster-randomized trial, with nursing homes allocated to the full, active intervention (featuring educational outreach offered to each prescriber and team members in the home) or standard quality improvement supports (including online audit and feedback reports for each prescriber in the home). The 'standard' quality improvement supports represent 'usual care' as these are to be launched province-wide; a concurrent control arm with no exposure to a quality improvement intervention is not feasible.
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Interventional
Not applicable
The Ministry of Health and Long-Term Care and Ontario Medical Association have initiated a project aiming to improve appropriateness of prescribing in long-term care facilities (aka nursing homes) through integrated educational supports for nursing home prescribers, inter-professional care teams, as well as residents and family members. The first focus of the project is appropriate prescribing of antipsychotic medications. Working with Health Quality Ontario, the policy makers have determined that all prescribers will have the opportunity to review practice reports detailing their prescribing performance for this class of medication (aka audit and feedback).
The primary question of this pragmatic, cluster-randomized trial is: What is the effect of adding educational outreach compared to the 'usual' quality improvement supports (i.e. audit and feedback) on prescribing of antipsychotic medications in long-term care?
Secondary questions include the following:
i. What is the effect of the intervention on acute care utilization (e.g., emergency room) rates? ii. What is the effect of the intervention on incidence of patient clinical outcomes and/or adverse effects associated with antipsychotic medications (e.g., falls, aggressive behaviours)? iii. What is the effect of the interventions on medications that might be used as alternatives to antipsychotic medications (e.g., benzodiazepines)? iv. What is the cost-benefit, focusing on prescribing outcomes?
Process evaluation questions include the following:
Healthy volunteers accepted: No
Only the study team can determine whether someone qualifies for participation.
Inclusion criteria
Exclusion criteria
Online Audit + Feedback practice reports detailing prescribing performance for this class of medication for each prescriber in the nursing home. (Details: http://www.hqontario.ca/Quality-Improvement/Practice-Reports/Primary-Care)
The Educational Outreach program will be delivered by academic detailers, health professionals (often nurses or pharmacists) who have received specific intensive training to support prescribing providers in a particular environment, in this case long-term care homes, to make the best or appropriate clinical decisions as possible. It is defined as: "an innovative method of service-oriented educational outreach for front-line clinicians. It combines the interactive, one-on-one communication approach of industry detailers with the evidence-based, non-commercial information of academia." The Educational Outreach will be delivered in addition to online Audit + Feedback practice reports, which detail prescribing performance for this class of medication for each prescriber in the nursing home.
Time frame: 6 months post-intervention
Number of days with antipsychotic prescriptions in the last week (count, range 0 - 7)
Time frame: 3 and 6 months post-intervention
Any antipsychotic prescription during the past month (dichotomous)
Time frame: 3 and 6 months post-intervention
Dose equivalent of antipsychotic dispensed in the past month (continuous)
Time frame: 3 and 6 months post-intervention
Any prescription during the past month (dichotomous)
Time frame: 3 and 6 months post-intervention
Any prescription during the past month (dichotomous)
Time frame: 3 and 6 months post-intervention
Any prescription during the past month (dichotomous)
Time frame: 3 and 6 months post-intervention
Activities of Daily Living long form scale (continuous variable, range 0-28)
Time frame: 3 and 6 months post-intervention
Extent of aggressive behaviour (continuous variable, range 0-12)
Time frame: 3 and 6 months post-intervention
Pain scale (continuous variable, range 0-3)
Time frame: 3 and 6 months post-intervention
Depression rating scale (continuous variable, range 0-14)
Time frame: 3 and 6 months post-intervention
Number of falls in the past month (count)
Time frame: 3 months post-intervention
Number of ER visits during the previous 3 months (count)
Time frame: 3 months post-intervention
Number of hospital visits visit during the previous 3 months (count)
Women's College Hospital
Other
Ontario Appropriate Prescribing Demonstration Project: Pragmatic, Cluster-Randomized Clinical Trial to Reduce Antipsychotic Medication Prescribing in Long-Term Care Homes
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View the official ClinicalTrials.gov record (opens in a new tab)This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.
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