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| ID | Type | Description | Link |
|---|---|---|---|
| R01AG077011 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute on Aging (NIA) | NIH |
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The overarching goal of this study is to pilot an intervention in which older adults with mild cognitive impairment and dementia and the older adult's care partners are identified in primary care and provided with educational materials through the patient portal to engage the participant in deprescribing. The multicomponent intervention, e-Align, includes delivery of educational information through the patient portal, and a pharmacist-led intervention to align medications with patient and care partner goals and reduce use of central nervous system (CNS) potentially inappropriate medicines (PIM). This work will establish the preliminary data, methods, and partnerships to undertake a multisite embedded pragmatic clinical trial. The resulting triadic-based behavioral intervention will promote patient and care partner engagement, and foster care that aligns with patients' values, and promote improved health and well-being outcomes for people with cognitive impairment and the patient's care partners through deprescribing.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patient Portal Deprescribing Intervention | Experimental | e-ALIGN will be piloted via the patient portal. The intervention will provide patients and care partners with an educational video on the risks of Central Nervous System-Potentially Inappropriate Medications (CNS-PIM) through the patient portal, MyChart. It will also offer the participant the opportunity to discuss deprescribing options with the patient's primary care physician (PCP) or to receive a referral to discuss deprescribing options with a clinical pharmacist who is embedded in the primary care practice. Patients who meet with the pharmacist will have two visits (intervention and follow-up). Patients who do not meet with a pharmacist will have a routine visit with the patient's PCP. Each participant will be on study (intervention period and additional follow-up) for approximately 3 months. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| e-ALIGN Patient-Portal Deprescribing | Other | The intervention will consist of educational materials about deprescribing, which will be sent to the patient prior to the scheduled primary care visit. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of patients who open the patient portal message | The investigators will assess the number of patients and/or care partners who read the patient portal message sent by the study team, which invites the participant to meet with a clinical pharmacist for deprescribing. | 1 month after sending message |
| Number of patients who watch the video | The investigators will assess the number of patients who click and watch the educational video about CNS-PIM and deprescribing. | 1 month after sending message |
| Acceptability of educational video assessed by survey | The investigators will assess the acceptability of the educational video by administering a survey to participants. The survey will ask participants to rate various features of the video on a 5-point Likert scale, where a higher score indicates greater acceptability. | 1 month after sending message |
| Measure | Description | Time Frame |
|---|---|---|
| Number of patients or care partners that discussed deprescribing with any clinicians after receiving the message | Study team will follow up to assess if deprescribing was discussed with a clinician after receiving the patient portal message by conducting a review of patients' chart. | 3 months after sending message |
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Inclusion Criteria:
Care partners:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ariel Green, MD, MPH, PhD | Contact | 410-550-6733 | ariel@jhmi.edu |
| Name | Affiliation | Role |
|---|---|---|
| Ariel Green, MD, MPH, PhD | Johns Hopkins University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Johns Hopkins Community Physicians | Recruiting | Baltimore | Maryland | 21209 | United States |
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| ID | Term |
|---|---|
| D003704 | Dementia |
| D060825 | Cognitive Dysfunction |
| ID | Term |
|---|---|
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D019965 | Neurocognitive Disorders |
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Due to the nature of the intervention, participants cannot be masked.
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| Number of PCPs who send the referral |
Study team will assess how many PCPs send a referral to clinical pharmacy for patients who have been identified as candidates for deprescribing. |
| 3 months after sending message |
| Number of patients who schedule the pharmacist visit | The investigators will determine the number of patients and/or care partners who schedule a visit with a clinical pharmacist for deprescribing CNS-PIM following receipt of the patient portal message. | 3 months after sending message |
| Number of patients who deprescribe ≥1 CNS-PIM after receiving the message | For those who do not schedule a pharmacist visit, the investigators will evaluate the number of patients who deprescribed at least 1 CNS-PIM after receiving the patient portal message. | 3 months after sending message (for patients who do NOT have a pharmacist visit) |
| Number of patients who start ≥1 CNS-PIM after receiving the message | For those who do not schedule a pharmacist visit, the investigators will evaluate the number of patients who add at least 1 CNS-PIM to the medication regimen after receiving the patient portal message. | 3 months after sending message (for people who do NOT have a pharmacist visit) |
| D001523 | Mental Disorders |
| D003072 | Cognition Disorders |