PDF(Pubmed)
Abstract：
BACKGROUND: Deprescribing of medication for cardiovascular risk factors and diabetes has been incorporated in clinical guidelines but proves to be difficult to implement in primary care. Training of healthcare providers is needed to enhance deprescribing in eligible patients. This study will examine the effects of a blended training program aimed at initiating and conducting constructive deprescribing consultations with patients.
METHODS: A cluster-randomized trial will be conducted in which local pharmacy-general practice teams in the Netherlands will be randomized to conducting clinical medication reviews with patients as usual (control) or after receiving the CO-DEPRESCRIBE training program (intervention). People of 75 years and older using specific cardiometabolic medication (diabetes drugs, antihypertensives, statins) and eligible for a medication review will be included. The CO-DEPRESCRIBE intervention is based on previous work and applies models for patient-centered communication and shared decision making. It consists of 5 training modules with supportive tools. The primary outcome is the percentage of patients with at least 1 cardiometabolic medication deintensified. Secondary outcomes include patient involvement in decision making, healthcare provider communication skills, health/medication-related outcomes, attitudes towards deprescribing, medication regimen complexity and health-related quality of life. Additional safety and cost parameters will be collected. It is estimated that 167 patients per study arm are needed in the final intention-to-treat analysis using a mixed effects model. Taking loss to follow-up into account, 40 teams are asked to recruit 10 patients each. A baseline and 6-months follow-up assessment, a process evaluation, and a cost-effectiveness analysis will be conducted.
CONCLUSIONS: The hypothesis is that the training program will lead to more proactive and patient-centered deprescribing of cardiometabolic medication. By a comprehensive evaluation, an increase in knowledge needed for sustainable implementation of deprescribing in primary care is expected.
BACKGROUND: The study is registered at ClinicalTrials.gov (identifier: NCT05507177).
METHODS: A cluster-randomized trial will be conducted in which local pharmacy-general practice teams in the Netherlands will be randomized to conducting clinical medication reviews with patients as usual (control) or after receiving the CO-DEPRESCRIBE training program (intervention). People of 75 years and older using specific cardiometabolic medication (diabetes drugs, antihypertensives, statins) and eligible for a medication review will be included. The CO-DEPRESCRIBE intervention is based on previous work and applies models for patient-centered communication and shared decision making. It consists of 5 training modules with supportive tools. The primary outcome is the percentage of patients with at least 1 cardiometabolic medication deintensified. Secondary outcomes include patient involvement in decision making, healthcare provider communication skills, health/medication-related outcomes, attitudes towards deprescribing, medication regimen complexity and health-related quality of life. Additional safety and cost parameters will be collected. It is estimated that 167 patients per study arm are needed in the final intention-to-treat analysis using a mixed effects model. Taking loss to follow-up into account, 40 teams are asked to recruit 10 patients each. A baseline and 6-months follow-up assessment, a process evaluation, and a cost-effectiveness analysis will be conducted.
CONCLUSIONS: The hypothesis is that the training program will lead to more proactive and patient-centered deprescribing of cardiometabolic medication. By a comprehensive evaluation, an increase in knowledge needed for sustainable implementation of deprescribing in primary care is expected.
BACKGROUND: The study is registered at ClinicalTrials.gov (identifier: NCT05507177).
摘要：
背景：心血管危险因素和糖尿病的药物处方已被纳入临床指南，但在初级保健中难以实施。需要对医疗保健提供者进行培训，以加强符合条件的患者的处方。这项研究将研究旨在启动和进行与患者的建设性处方咨询的混合培训计划的效果。
方法：将进行一项整群随机试验，在该试验中，荷兰当地的药学-普通实践团队将被随机分配到与患者照常（对照）或在接受CO-DEPRESCRIBE培训计划（干预）后进行临床药物审查。75岁及以上的人使用特定的心脏代谢药物（糖尿病药物，抗高血压药,他汀类药物），并有资格进行药物审查。共同描述干预基于先前的工作，并将模型应用于以患者为中心的沟通和共享决策。它由5个培训模块和支持工具组成。主要结果是至少有1种心脏代谢药物恶化的患者百分比。次要结果包括患者参与决策，医疗保健提供者沟通技巧，健康/药物相关结果，对开药的态度，药物治疗方案的复杂性和健康相关的生活质量。将收集额外的安全和成本参数。据估计，在使用混合效应模型的最终意向治疗分析中，每个研究臂需要167名患者。考虑到后续损失，40个团队被要求招募每个10名患者。基线和6个月随访评估，过程评估，并进行成本效益分析。
结论：假设是培训计划将导致更主动和以患者为中心的心脏代谢药物处方。通过综合评价,预计初级保健中可持续实施去处方所需的知识将会增加.
背景：该研究已在ClinicalTrials.gov注册（标识符：NCT05507177）。
方法：将进行一项整群随机试验，在该试验中，荷兰当地的药学-普通实践团队将被随机分配到与患者照常（对照）或在接受CO-DEPRESCRIBE培训计划（干预）后进行临床药物审查。75岁及以上的人使用特定的心脏代谢药物（糖尿病药物，抗高血压药,他汀类药物），并有资格进行药物审查。共同描述干预基于先前的工作，并将模型应用于以患者为中心的沟通和共享决策。它由5个培训模块和支持工具组成。主要结果是至少有1种心脏代谢药物恶化的患者百分比。次要结果包括患者参与决策，医疗保健提供者沟通技巧，健康/药物相关结果，对开药的态度，药物治疗方案的复杂性和健康相关的生活质量。将收集额外的安全和成本参数。据估计，在使用混合效应模型的最终意向治疗分析中，每个研究臂需要167名患者。考虑到后续损失，40个团队被要求招募每个10名患者。基线和6个月随访评估，过程评估，并进行成本效益分析。
结论：假设是培训计划将导致更主动和以患者为中心的心脏代谢药物处方。通过综合评价,预计初级保健中可持续实施去处方所需的知识将会增加.
背景：该研究已在ClinicalTrials.gov注册（标识符：NCT05507177）。
