Methods
housing instability
SYNDROMES, INCONTINENCE
We report enrollment data from two randomized controlled trials to evaluate a patient-centered deprescribing intervention to reduce unnecessary medications for hospitalized patients discharged to skilled nursing facilities (SNF). In both trials, deprescribing recommendations were made based on the entirety of each participant’s medication list, rather than being focused on a specific medication class, and incorporated both patient preferences and their treatment teams’ agreement. The Shed-MEDS trial (NCT02979353) was conducted from 2015 to 2020 at an academic medical center, and the VA DROP trial (NCT03722017) was conducted from 2019 to 2023 at one Veterans Affairs hospital, with both enrollment sites located in the middle Tennessee area. Both trials required patients to be aged 50 or older, English-speaking, and taking five or more medications prior to hospitalization. Additionally, those who were receiving long-term care or hospice care were excluded from both trials, and those with housing instability were excluded from the Shed-MEDS trial but included in VA DROP due to having an assigned social worker to assist the research team in contacting the Veteran after hospital discharge.Our university-affiliated institutional review board (IRB) provided a HIPAA waiver for eligibility screening to be conducted through electronic chart review, and then eligible patients were approached by trained research study personnel (nurse practitioners, pharmacists, or non-clinical research assistants) for enrollment during hospitalization. For patients unable to provide self-consent, a surrogate was approached for enrollment. Both studies required the patient (or their surrogate, if unable to self-consent) to complete standardized assessments lasting 1 h at enrollment and up to three times via telephone following hospital and SNF discharge. The assessments measured medication-related outcomes such as adherence, functional health status, attitudes toward deprescribing, and geriatric syndromes (e.g., incontinence, falls). The intervention consisted of a pharmacist or nurse practitioner led comprehensive medication review and required patient/surrogate to agree upon deprescribing recommendations. Deprescribing actions were initiated in the hospital for both studies and for Shed-MEDS, continued past hospital discharge. The complete protocol for the Shed-MEDS trial has been published previously [There were only a few differences between the two trials with Shed-MEDS including one follow-up home visit and modest compensation for participation; otherwise, study procedures and assessments were the same across the two trials. While the trial protocols were similar, eligible participants were expected to differ given that Shed-MEDS was conducted at an academic medical center with a high proportion of insured, urban/suburban patients, whereas VA DROP was conducted at a Veterans’ Administration facility with a high proportion of male and potentially rural patients.