Background
Objectives
Methods
Study design
Participants
Randomisation
Intervention
Control
Outcomes
Data collection
Measures to mitigate bias
Statistical methods
Results
Baseline characteristics
Intervention (N = 126) | Control (N = 127) | |
---|---|---|
Demographics | ||
Age, Median (IQR) | 76 (70, 81) | 75 (70, 80) |
Female, N (%) | 73 (58.7) | 76 (59.8) |
Ethnicity | ||
Chinese, N (%) | 109 (86.5) | 112 (88.2) |
Malay, N (%) | 8 (6.4) | 7 (5.5) |
Indian, N (%) | 8 (6.4) | 8 (6.3) |
Eurasian, N (%) | 1 (0.8) | 0 (0.0) |
Discipline | ||
Rehabilitation, N (%) | 102 (81.0) | 100 (78.7) |
Subacute, N (%) | 24 (19.1) | 27 (21.3) |
Other parameters | ||
AMT Score, Median (IQR) | 10.0 (9, 10) | 10.0 (9, 10) |
Length of Stay in days, Median (IQR)c | 27 (17.5, 38)a | 22 (13, 32)b |
Baseline medicine parameters | ||
Total Daily Dose (TDD), Median (IQR) | 23 (18, 28) | 23 (18, 29) |
Total Number of Medicine (TNM), Median (IQR) | 13 (11, 16) | 13 (10, 17) |
Total Daily Cost (TDC) in S$, Median (IQR) | 5.94 (4.32, 9.08) | 6.18 (3.98, 9.74) |
Primary outcome
A. Percentage change from baseline for medicine parameters expressed in median (interquartile range) | ||||
---|---|---|---|---|
Outcome | Phases | Intervention (N = 126) | Control (N = 127) | p value |
Total Daily Dose (TDD) | Inpatient phase, day 14 postrecruitment | ̶ -12.50 (−27.27, 0.00) | 0.00 (−11.43, 6.67) | < 0.001 |
Inpatient phase, day 28 postrecruitment | −14.91 (−32.00, 0.00) | 0.00 (− 11.76, 7.14) | < 0.001 | |
Discharge day (Primary Outcome) | − 19.62 (− 34.38, 0.00) | 0.00 (− 12.00, 6.82) | < 0.001 | |
Outpatient phase, day 28 postdischarge | − 22.54 (− 41.18, 0.00) | ̶7.69 (− 28.57, 0.00) | 0.001 | |
Total Number of Medicine (TNM) | Inpatient phase, day 14 postrecruitment | ̶ 5.26 (− 16.67, 0.00) | 0.00 (−9.09, 5.88) | 0.008 |
Inpatient phase, day 28 postrecruitment | 0.00 (− 18.18, 5.56) | 0.00 (−10.00, 5.88) | 0.035 | |
Discharge day | ̶ 5.56 (−20.00, 0.00) | 0.00 (−11.76, 5.88) | 0.035 | |
Outpatient phase, day 28 postdischarge | ̶ 7.14 (−23.08, 0.00) | 0.00(−16.67, 5.56) | 0.203 | |
Total Daily Cost (TDC) | Inpatient phase, day 14 postrecruitment | ̶ 8.91 (−27.55, 0.00) | 0.00 (−14.99, 3.57) | 0.004 |
Inpatient phase, day 28 postrecruitment | −10.66 (−35.86, 0.00) | 0.00 (−15.83, 5.63) | 0.002 | |
Discharge day | −14.74 (−38.22, 0.00) | 0.00 (−23.90, 7.60) | 0.001 | |
Outpatient phase, day 28 postdischarge | −17.31 (−47.07, 0.00) | ̶ 7.61 (−37.63, 1.80) | 0.116 | |
B: Analysis of the change of TDC/TNM/TDC across time using GLMM | ||||
Regression Coefficient (95% CI) | p value | |||
TDD | Unadjusted group effects | −2.836 (−4.888, −0.785) | 0.007 | |
Adjusted* group effects | −3.113 (−5.153, −1.072) | 0.003 | ||
TNM | Unadjusted group effects | −0.830 (−1.875, 0.216) | 0.120 | |
Adjusted group effects | −0.994 (−2.046, 0.0587) | 0.064 | ||
TDC | Unadjusted group effects | −3.564 (−10.882, 3.754) | 0.340 | |
Adjusted group effects | −3.585 (−10.830, 3.661) | 0.332 |
Secondary outcomes
A. Medicine associated with symptom recurrence after deprescribing | ||||||
---|---|---|---|---|---|---|
Intervention Group | Control Group | Odds Ratio (95% CI) | p value | |||
Number of patients with target medicine initially deprescribed N | Number of patients with symptom recurrence n (%) | Number of patients with target medicine initially deprescribed N | Number of patients with symptom recurrence n (%) | |||
Painkillers | 102 | 24 (23.5) | 76 | 11 (14.5) | 1.80 (0.83, 3.99) | 0.140 |
Laxatives | 80 | 51 (63.8) | 47 | 15 (31.9) | 3.75 (1.75, 8.06) | < 0.001 |
Antiemetics | 37 | 5 (13.5) | 31 | 3 (9.7) | 1.46 (0.32, 6.66) | 0.630 |
Gastroprotectives | 40 | 8 (20.0) | 32 | 7 (21.9) | 0.89 (0.29, 2.80) | 0.850 |
Steroid Creams | 10 | 4 (40.0) | 13 | 4 (30.8) | 1.50 (0.27, 8.45) | 0.650 |
Vitamin B based supplements | 19 | 2 (10.5) | 4 | 1 (25.0) | 0.35 (0.02, 5.23) | 0.450 |
Glucosamine | 6 | 0 (0.0) | 0 | 0 (0.0) | N.A. | N.A. |
Multivitamins | 1 | 0 (0.0) | 0 | 0 (0.0) | N.A. | N.A. |
Diuretics | 4 | 0 (0.0) | 4 | 2 (50.0) | N.A. | N.A. |
Benzodiazepines | 4 | 2 (50.0) | 2 | 1 (50.0) | 1.00 (0.03, 29.81) | 1.000 |
Antihistamines (for insomnia) | 3 | 0 (0.0) | 3 | 1 (33.3) | N.A. | N.A. |
Antihistamines (for itch) | 5 | 2 (40.0) | 4 | 1 (25.0) | 2.00 (0.11, 35.81) | 0.640 |
Opioids (for Cough) | 18 | 2 (11.1) | 21 | 3 (14.3) | 0.75 (0.11, 5.07) | 0.770 |
Opioids (for diarrhoea) | 1 | 1 (100.0) | 3 | 2 (66.7) | N.A. | N.A. |
B. Medicine which are restarted or substituted after deprescribing | ||||||
Intervention | Control | Odds Ratio (95% CI) | p value | |||
Number of patients with target medicine initially deprescribed n | Number of patients with medication restarted/ substituted n (%) | Number of patients with target medicine initially deprescribed n | Number of patients with medication restarted/ substituted n (%) | |||
Painkillers | 102 | 67 (65.7) | 77 | 46 (59.7) | 1.29 (0.70, 2.38) | 0.410 |
Laxatives | 84 | 39 (46.4) | 51 | 12 (23.5) | 2.82 (1.30, 6.12) | 0.009 |
Antiemetics | 37 | 5 (13.5) | 31 | 6 (19.4) | 0.65 (0.18, 2.38) | 0.520 |
Gastroprotectives | 44 | 7 (15.9) | 34 | 9 (26.5) | 0.53 (0.17, 1.60) | 0.260 |
Steroid Creams | 10 | 3 (30.0) | 13 | 6 (46.2) | 0.50 (0.09, 2.84) | 0.430 |
Vitamin B based supplements | 18 | 3 (16.7) | 4 | 0 (0.0) | N.A. | N.A. |
Glucosamine | 7 | 2 (28.6) | 0 | 0 (0.0) | N.A. | N.A. |
Multivitamins | 1 | 0 (0.0) | 0 | 0 (0.0) | N.A. | N.A. |
Diuretics | 5 | 0 (0.0) | 5 | 1 (20.0) | N.A. | N.A. |
Benzodiazepines | 5 | 1 (20.0) | 2 | 0 (0.0) | N.A. | N.A. |
Antihistamines (for insomnia) | 4 | 2 (50.0) | 3 | 2 (66.7) | 0.50 (0.02, 11.09) | 0.660 |
Antihistamines (for itch) | 6 | 2 (33.3) | 5 | 0 (0.0) | N.A. | N.A. |
Opioids (for cough) | 19 | 3 (15.8) | 23 | 7 (30.4) | 0.43 (0.09, 1.96) | 0.270 |
Opioids (for diarrhoea) | 2 | 1 (50.0) | 3 | 2 (66.7) | 0.50 (0.01, 19.56) | 0.710 |
C: Hospitalisation and deaths | ||||||
Intervention (N = 126) | Control (N = 127) | Odds Ratio (95% CI) | p value | |||
Hospitalisations, n (%) | 23 (18.3) | 26 (20.4) | 0.87 (0.46, 1.62) | 0.655 | ||
Deaths, n (%) | 2 (1.6) | 0 (0) | N.A. | 0.247 |
Intervention | Control | |
---|---|---|
Hospitalisations | N = 23 Elective cholangiopancreatogram (n = 1) Fluid overload with pneumonia (n = 1) Pleural effusion (n = 1) Sepsis (n = 5) Haemoptysis for workup (n = 1) Worsening neuropathy (n = 1) Suspected stroke (n = 1) Rectal bleeding for workup (n = 1) Suspected fracture (n = 1) Suspected septic arthritis (n = 2) Suspected myocardial infarction (n = 1) Worsening wound infection (n = 1) Altered mental state for workup (n = 1) Worsening gangrene (n = 1) Suspected deep vein thrombosis (n = 1) Fluid overload (n = 1) Pneumonia (n = 1) * Lung Cancer (n = 1) * | N = 26 Elective knee replacement (n = 1) Elective nephrectomy (n = 1) Fast atrial fibrillation (n = 1) Suspected deep vein thrombosis (n = 1) Worsening renal impairment (n = 1) Removal of central venous catheter (n = 1) Worsening anaemia (n = 3) Sepsis (n = 2) Fluid overload (n = 1) Suspected implant infection (n = 1) Suspected myocardial (n = 3) Worsening numbness (n = 1) Pneumonia with seizures (n = 1) Severe hyponatremia (n = 1) Fluid overload, pneumonia & fast AF (n = 1) Worsening ascites(n = 1) Incarcerated hernia (n = 1) Worsening fracture (n = 1) Hematemesis (n = 1) Finger abscess (n = 1) Intestinal obstruction (n = 1) |
Deaths | N = 2 Pneumonia (n = 1) Lung Cancer (n = 1) | |
Dropouts | N = 4 Patient felt study was not helpful to him (n = 1) Patient prefers to continue current medicine (n = 3) | N = 3 Patients felt study was not helpful to them (n = 2) Patient prefers to continue usual medicine (n = 1) |