Appropriate Prescribing for Older Adults With Multimorbidity (Pro-M)

Appropriate Prescribing for Older Adults With Multimorbidity (Pro-M): A Feasibility Study

This is a two-site feasibility study to test implementation of an intervention that aims to reduce inappropriate prescribing for older adults with multimorbidity in geriatric medicine specialist clinics at public hospitals in Singapore. The specific aims are:

1. To assess the implementation outcomes: Appropriateness, Penetration/Reach, Acceptability, Feasibility, Sustainability (primary)
2. To collect data on recruitment and pre-post data on prevalence of potentially inappropriate prescribing (PIP) for the purpose of determining sample size for a scale up next phase study (secondary).
3. To conduct cost analysis of the intervention (secondary).

The Appropriate prescribing for older adults with multi-morbidity (Pro-M) study aims to assess the feasibility of implementing routine medication review using prescribing criteria for older adults with multi-morbidity at the Geriatric Medicine outpatient clinics at 2 public hospitals in Singapore. The study will consist of a recruitment and implementation period and an evaluation period at the end.

Flow of the intervention (6 months):

1. Eligible patients with multimorbidity and are taking at least 5 medications daily will be identified and invited by the doctor to undergo medication review (MR).
2. Patients will undergo medication reviews with a pharmacist, involving the use of specific prescribing criteria and tools (e.g. STOPP/START, Beers Criteria), as determined by the sites.
3. Medication review findings will be documented in the electronic medical records and shared with the doctor, who will review the findings and make necessary changes to patients' prescriptions during consultations with the patients.
4. The Doctors will document the review outcome and prescribing decisions in the electronic medical records and communicate the changes (if any) to other relevant prescribers.
5. Patients will be invited to do a short survey on their experiences of the intervention at the end to assess implementation outcomes.

The intervention will be compared to 'usual care', where medication review is only done in an ad-hoc and informal basis. Patients' last consultation prior to the intervention period would be used as the point to measure 'usual care'.

Evaluation(3 months):

Doctors and pharmacists who implemented the study (delivery or support) will be invited to a survey and selected in-depth interviews to assess implementation outcomes.

Inclusion Criteria for patients:

• Older adults age 65 and above
• Currently attending Geriatric Medicine Clinic
• on at least 5 medications.

Exclusion Criteria for patients:

• Those younger than 65
• Not a Geriatric Medicine outpatient clinic patient
• On fewer than 5 medications
• Currently receiving other pharmacist-related services such as medication therapy management.
• Non-English, non-Chinese, and non-Malay speaking patients.
• Patient or caregiver who declines any of the study procedure required within the intervention framework.

Inclusion Criteria for implementer:

• Doctors and pharmacists
• who are involved in the delivery or support of the intervention during the implementation period.

Exclusion criteria for implementer:

• Those who are not involved in the implementation of the study.
• Those who are not involved in the delivery of the intervention.