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Trial registered on ANZCTR
Registration number
ACTRN12611001078943
Ethics application status
Approved
Date submitted
14/10/2011
Date registered
18/10/2011
Date last updated
8/10/2018
Type of registration
Prospectively registered
Titles & IDs
Public title
Reducing inappropriate medications in older institutionalized persons
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Scientific title
Reducing inappropriate, anticholinergic and psychotropic medications in older institutionalized persons via staff training
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Secondary ID [1]
273208
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Nil
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Universal Trial Number (UTN)
U1111-1125-2281
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Inappropriate medication
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Condition category
Condition code
Other
279150
279150
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0
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Conditions of unknown or disputed aetiology (such as chronic fatigue syndrome/myalgic encephalomyelitis)
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Public Health
279162
279162
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0
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Health promotion/education
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Public Health
279163
279163
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0
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Health service research
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The staff in intervention wards will be trained to identify inappropiate drugs, drugs with anticholinergic properties and psychotropic drugs in their patients as well as potentially dangerous drug-drug interactions. The training for the ward staff will take one day (6 hours). The training will be be on constructive and activating learning methods, the drugs problems will be discussed based on the patient cases in the ward. A responsible nurse will be pointed out in the ward to indentify problems in medication and to take them to the consulting doctor. The doctor will be responsible for changes in medication. The responsible nurse will get extra training (one session, 6 hours) on medications and their harmful effects. In addition, she will receive a list of inappropriate drugs. She will also receive tutoring for her work with the medications when needed.
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Intervention code [1]
269544
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Other interventions
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Comparator / control treatment
No training. Normal care.
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Control group
Active
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Outcomes
Primary outcome [1]
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Number of inappropriate drugs (including those according to Beers' criteria, drugs with anticholinergic properties and psychotropic drugs)
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Assessment method [1]
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Timepoint [1]
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6 and 12 months
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Primary outcome [2]
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Number of potentially harmful drug-drug interactions (D-class according to SFINX)
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Assessment method [2]
279805
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Timepoint [2]
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6 and 12 months
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Secondary outcome [1]
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Health-related quality-of life according to 15D-measure
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Assessment method [1]
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Timepoint [1]
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6 and 12 months
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Secondary outcome [2]
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Cognition according to clock-drawing test and verbal flow
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Assessment method [2]
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Timepoint [2]
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6 and 12 months
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Secondary outcome [3]
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Hospital admissions, use and costs of health services.
These will be assessed via medical records and central registers.
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Assessment method [3]
294434
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Timepoint [3]
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12 months
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Eligibility
Key inclusion criteria
Living permanently in Helsinki nursing home/ assisted living facility
- 65 years+
- native Finnish skeaking
- uses at least one drug
- not at terminal stage (estimated prognosis >6 months)
- volunteer, participant or his/her proxy gives an informed consent to participate the study
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Minimum age
65
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Terminal stage
Has no drugs in regular use
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Study design
Purpose of the study
Educational / counselling / training
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
patients will be recruited by inviting them to participate. Their permission will be first acquired by informed consent. THereafter, the wards participating will be randomized into two categories: those receiving training concerning inappropriate drugs (intervention) and those continuing normal treatment without training (control)
Central randomisation by phone /fax /computer
Allocation will be concealed fromthe study nurses assessing participants.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation by using a randomization table created by a computer software
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/11/2011
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Actual
1/11/2011
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Date of last participant enrolment
Anticipated
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Actual
30/11/2011
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Date of last data collection
Anticipated
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Actual
31/12/2012
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Sample size
Target
212
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Accrual to date
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Final
227
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Recruitment outside Australia
Country [1]
3909
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Finland
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State/province [1]
3909
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Funding & Sponsors
Funding source category [1]
270037
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Hospital
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Name [1]
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Helsinki University Central Hospital
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Address [1]
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C/o Unit of General Practice
University of Helsinki
PO Box 20
00014 University of Helsinki
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Country [1]
270037
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Finland
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Primary sponsor type
Hospital
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Name
Helsinki University Central Hospital
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Address
C/o Unit of General Practice
University of Helsinki
PO Box 20
00014 University of Helsinki
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Country
Finland
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Secondary sponsor category [1]
269008
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None
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Name [1]
269008
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Address [1]
269008
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Country [1]
269008
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Other collaborator category [1]
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University
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Name [1]
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University of Helsinki
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Address [1]
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C/o Unit of General Practice
University of Helsinki
PO Box 20
00014 University of Helsinki
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Country [1]
252296
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Finland
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Other collaborator category [2]
252297
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Other Collaborative groups
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Name [2]
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Helsinki City Social Services, Older people's Services
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Address [2]
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c/o Helena Soini
PO BOX 7000
00099 Helsingin kaupunki
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Country [2]
252297
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Finland
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Helsinki University Central Hospital, Ethical committe of Medicine
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Ethics committee address [1]
271990
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Biomedicum Helsinki 2 C, PO Box 705 00029 HUS Finland
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Ethics committee country [1]
271990
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Finland
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Date submitted for ethics approval [1]
271990
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Approval date [1]
271990
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04/10/2010
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Ethics approval number [1]
271990
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Dnro HUS 254/13/03/01/10
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Summary
Brief summary
Use of inappropriate drugs among insititutionalized older people is very common and may lead to unnecessary hospitalizations and impaired quality of life. The aim of this study is to investigate whether training nursing home staff (nurses, consulting physician) reduces the use of inappropriate, anticholinergic and psychotropic drugs among institutionalized older people. We also investigate the effects of intervention on older people's HrQOL, cognition and use and costs of health services, especially hospitalizations. The primary endpoint will be number of inappropriate, anticholinergic and psychotropic drugs and the secondary outcomes will be older people's HrQOL, cognition and use and costs of health services. The wards will be randomized into two groups,and the staff in the intervention wards will receive training concerning the use of drugs in older people, to identify inappropriate, anticholinergic and psychotropic drugs and their harmful effects. The intervenion wards will have an appointed nurse who is responsible to identify harmful drugs among the residents in her wards and to take these problems to the consulting doctor who is responsible to comprehensively take care of the patient. The trial will last for 12 months, the assessment time points will 0,6 and 12 months.
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Trial website
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Trial related presentations / publications
Pitkala KH, Juola AL, Soini H, Laakkonen ML, Teramura-Gronblad M, Kautiainen H, Bjorkman M. Reducing inappropriate, anticholinergic and psychotropic drugs among older residents in assisted living facilities - a randomized controlled trial. Study protocol. Trials 2012; Jun 18;13(1):85. Juola AL, Pylkkanen S, Bjorkman M, Soini H, Finne-Soveri UH, Kautiainen H, Pitkala KH. Feasibility and baseline findings of a trial Optimizing Drug Treatment among Older People in Assisted Living Facilities in Helsinki. Randomized, Controlled Trial. Eur Geriatric Med 2014;5:195-9. Pitkala KH, Juola AL, Kautiainen H, Soini H, Finne-Soveri H, Bell JS, Bjorkman MP. Effects of educational intervention to reduce harmful drugs among older people. J Am Med Dir Assoc. 2014 Dec;15(12):892-898. Juola AL, Bjorkman MP, Kautiainen H, Pylkkanen S, Finne-Soveri H, Soini H, Bell JS, Pitkala KH. Nursing staff education to reduce potentially harmful medication use among older people in assisted living facilities: effects of randomized controlled trial on cognition and falls. Drugs Aging. 2015 Nov;32(11):947-55. Juola AL, Soini H, Kautiainen H, Bell JS, Pitkala KH. Burden in the use of harmful medication among residents in assisted living facilities. JAMDA 2016 Mar 1;17(3):276.e9-276.e14.
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Public notes
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Contacts
Principal investigator
Name
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A/Prof Kaisu H Pitkala
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Address
33269
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University of Helsinki
Department of General Practice
PO Box 20
00014 University of Helsinki
Finland
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Country
33269
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Finland
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Phone
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+358503385546
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Fax
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Email
33269
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[email protected]
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Contact person for public queries
Name
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Kaisu Pitkälä
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Address
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University of Helsinki
Department of General Practice
PO Box 20
00014 University of Helsinki
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Country
16516
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Finland
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Phone
16516
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+358503385546
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Fax
16516
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+358919127536
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Email
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[email protected]
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Contact person for scientific queries
Name
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Kaisu Pitkala
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Address
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University of Helsinki
Department of General Practice
PO Box 20
00014 University of Helsinki
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Country
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Finland
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Phone
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+358503385546
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Fax
7444
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
The effect of educational intervention on use of psychotropics in defined daily doses and related costs - a randomized controlled trial.
2022
https://dx.doi.org/10.1080/02813432.2022.2074055
N.B. These documents automatically identified may not have been verified by the study sponsor.
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