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Title: Feasibility & Efficacy of Deprescribing rounds in a Singapore rehabilitative hospital- a randomised controlled trial
Authors: Wong, Andrew Peng Yong
Ting, Tan Wan
Charissa, Ee Jia Ming
Boon, Tan Wee
Heng, Kwan Yu 
Leng, Low Lian
Keywords: Deprescribing
Multidisciplinary team
Open label
Randomised controlled trial
Issue Date: 21-Oct-2021
Publisher: BioMed Central Ltd
Citation: Wong, Andrew Peng Yong, Ting, Tan Wan, Charissa, Ee Jia Ming, Boon, Tan Wee, Heng, Kwan Yu, Leng, Low Lian (2021-10-21). Feasibility & Efficacy of Deprescribing rounds in a Singapore rehabilitative hospital- a randomised controlled trial. BMC Geriatrics 21 (1) : 584. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Background: Deprescribing is effective and safe in reducing polypharmacy among the elderly. However, the impact of deprescribing rounds remain unclear in Asian settings. Hence, we conducted this study. Methods: An open label randomised controlled trial was conducted on patients of 65 years and above, under rehabilitation or subacute care and with prespecified medications from a Singapore rehabilitation hospital. They were randomised using a computer generated sequence. The intervention consisted of weekly multidisciplinary team-led deprescribing rounds (using five steps of deprescribing) and usual care. The control had only usual care. The primary outcome is the percentage change in total daily dose (TDD) from baseline upon discharge, while the secondary outcomes are the total number of medicine, total daily cost and TDD up to day 28 postdischarge, overall side-effect rates, rounding time and the challenges. Efficacy outcomes were analysed using intention-to-treat while other outcomes were analysed as per protocol. Results: 260 patients were randomised and 253 were analysed after excluding dropouts (female: 57.3%; median age: 76 years). Baseline characteristics were largely similar in both groups. The intervention arm (n = 126) experienced a greater reduction of TDD on discharge [Median (IQR): ? 19.62% (? 34.38, 0.00%) versus 0.00% (? 12.00, 6.82%); p < 0.001], more constipation (OR: 3.75, 95% CI:1.75–8.06, p < 0.001) and laxative re-prescriptions (OR: 2.82, 95% CI:1.30–6.12, p = 0.009) though death and hospitalisation rates were similar. The median rounding time was 7.09 min per patient and challenges include the inconvenience in assembling the multidisciplinary team. Conclusion: Deprescribing rounds can safely reduce TDD of medicine upon discharge compared to usual care in a Singaporean rehabilitation hospital. Trial registration: This study is first registered at (protocol number: NCT03713112) on 19/10/2018 and the protocol can be accessed on © 2021, The Author(s).
Source Title: BMC Geriatrics
ISSN: 1471-2318
DOI: 10.1186/s12877-021-02507-0
Rights: Attribution 4.0 International
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