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Lockman K, Lowry MF, DiScala S, Lovell AG, Uritsky TJ, Kematick BS, Schmidt M, Wetshtein AM, Scullion B, Herndon CM, Atayee RS. Development of Entrustable Professional Activities for Specialist Hospice and Palliative Care Pharmacists. J Pain Symptom Manage 2022; 64:37-48. [PMID: 35304228 DOI: 10.1016/j.jpainsymman.2022.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 12/30/2022]
Abstract
CONTEXT Entrustable professional activities (EPAs) translate competencies into explicit, practical terms that clearly state the expected roles and responsibilities of clinicians who have achieved proficiency and expertise in a field. EPAs are defined for Hospice and Palliative Medicine physicians but not for other members of Hospice and Palliative Care (HAPC) interprofessional teams, including pharmacists. OBJECTIVES The objective of this study was to develop EPAs for HAPC pharmacists. METHODS An 11-member workgroup of HAPC pharmacists was convened to develop candidate EPAs using nominal group and modified-Delphi methods. Content validity index was used as a measure of consensus, defined a priori at ≥ 60%. Vetting occurred via intra- and interprofessional stakeholder reactor groups and a national survey of HAPC pharmacists. RESULTS Following an iterative process of workgroup and stakeholder consensus-building, 15 HAPC pharmacist EPAs were developed. Among the workgroup, all 15 EPAs reached ≥ 70% consensus, indicating appropriate internal validity. In a national survey of 185 HAPC pharmacists with a 20% response rate, 13 EPAs were rated by most respondents as "essential" and 2 were rated by most respondents as "important but not essential." Respondents indicated the 15 EPA set represented the core professional activities of HAPC pharmacists well (median rating of 5 on a Likert-like scale, IQR 1). CONCLUSION Fifteen consensus EPAs describe essential activities of HAPC pharmacists in direct patient care, leadership, education, and scholarship. These EPAs will further guide pharmacist training programs, HAPC services seeking to incorporate a specialized pharmacist on the team, and currently practicing HAPC pharmacists.
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Affiliation(s)
- Kashelle Lockman
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA.
| | - Maria F Lowry
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Sandra DiScala
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Amanda G Lovell
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Tanya J Uritsky
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Benjamin S Kematick
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Michelle Schmidt
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Andrea M Wetshtein
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Bridget Scullion
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Christopher M Herndon
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Rabia S Atayee
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
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Bayliss EA, Shetterly SM, Drace ML, Norton JD, Maiyani M, Gleason KS, Sawyer JK, Weffald LA, Green AR, Reeve E, Maciejewski ML, Sheehan OC, Wolff JL, Kraus C, Boyd CM. Deprescribing Education vs Usual Care for Patients With Cognitive Impairment and Primary Care Clinicians: The OPTIMIZE Pragmatic Cluster Randomized Trial. JAMA Intern Med 2022; 182:534-542. [PMID: 35343999 PMCID: PMC8961395 DOI: 10.1001/jamainternmed.2022.0502] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/06/2022] [Indexed: 12/13/2022]
Abstract
Background Individuals with dementia or mild cognitive impairment frequently have multiple chronic conditions (defined as ≥2 chronic medical conditions) and take multiple medications, increasing their risk for adverse outcomes. Deprescribing (reducing or stopping medications for which potential harms outweigh potential benefits) may decrease their risk of adverse outcomes. Objective To examine the effectiveness of increasing patient and clinician awareness about the potential to deprescribe unnecessary or risky medications among patients with dementia or mild cognitive impairment. Design, Setting, and Participants This pragmatic, patient-centered, 12-month cluster randomized clinical trial was conducted from April 1, 2019, to March 31, 2020, at 18 primary care clinics in a not-for-profit integrated health care delivery system. The study included 3012 adults aged 65 years or older with dementia or mild cognitive impairment who had 1 or more additional chronic medical conditions and were taking 5 or more long-term medications. Interventions An educational brochure and a questionnaire on attitudes toward deprescribing were mailed to patients prior to a primary care visit, clinicians were notified about the mailing, and deprescribing tip sheets were distributed to clinicians at monthly clinic meetings. Main Outcomes and Measures The number of prescribed long-term medications and the percentage of individuals prescribed 1 or more potentially inappropriate medications (PIMs). Analysis was performed on an intention-to-treat basis. Results This study comprised 1433 individuals (806 women [56.2%]; mean [SD] age, 80.1 [7.2] years) in 9 intervention clinics and 1579 individuals (874 women [55.4%]; mean [SD] age, 79.9 [7.5] years) in 9 control clinics who met the eligibility criteria. At baseline, both groups were prescribed a similar mean (SD) number of long-term medications (7.0 [2.1] in the intervention group and 7.0 [2.2] in the control group), and a similar proportion of individuals in both groups were taking 1 or more PIMs (437 of 1433 individuals [30.5%] in the intervention group and 467 of 1579 individuals [29.6%] in the control group). At 6 months, the adjusted mean number of long-term medications was similar in the intervention and control groups (6.4 [95% CI, 6.3-6.5] vs 6.5 [95% CI, 6.4-6.6]; P = .14). The estimated percentages of patients in the intervention and control groups taking 1 or more PIMs were similar (17.8% [95% CI, 15.4%-20.5%] vs 20.9% [95% CI, 18.4%-23.6%]; P = .08). In preplanned subgroup analyses, adjusted differences between the intervention and control groups were -0.16 (95% CI, -0.34 to 0.01) for individuals prescribed 7 or more long-term medications at baseline (n = 1434) and -0.03 (95% CI, -0.20 to 0.13) for those prescribed 5 to 6 medications (n = 1578) (P = .28 for interaction; P = .19 for subgroup interaction for PIMs). Conclusions and Relevance This large-scale educational deprescribing intervention for older adults with cognitive impairment taking 5 or more long-term medications and their primary care clinicians demonstrated small effect sizes and did not significantly reduce the number of long-term medications and PIMs. Such interventions should target older adults taking relatively more medications. Trial Registration ClinicalTrials.gov Identifier: NCT03984396.
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Affiliation(s)
- Elizabeth A. Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
- Department of Family Medicine, University of Colorado School of Medicine, Aurora
| | | | - Melanie L. Drace
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | - Jonathan D. Norton
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mahesh Maiyani
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | - Kathy S. Gleason
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | | | - Linda A. Weffald
- Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora
| | - Ariel R. Green
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Science, University of South Australia, Adelaide, South Australia, Australia
| | - Matthew L. Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Veterans Affairs Medical Center, Durham, North Carolina
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina
| | - Orla C. Sheehan
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer L Wolff
- School of Public Health, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Courtney Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | - Cynthia M. Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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9
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Bayliss EA, Shetterly SM, Drace ML, Norton J, Green AR, Reeve E, Weffald LA, Wright L, Maciejewski ML, Sheehan OC, Wolff JL, Gleason KS, Kraus C, Maiyani M, Du Vall M, Boyd CM. The OPTIMIZE patient- and family-centered, primary care-based deprescribing intervention for older adults with dementia or mild cognitive impairment and multiple chronic conditions: study protocol for a pragmatic cluster randomized controlled trial. Trials 2020; 21:542. [PMID: 32552857 PMCID: PMC7301527 DOI: 10.1186/s13063-020-04482-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/06/2020] [Indexed: 12/03/2022] Open
Abstract
Background Most individuals with dementia or mild cognitive impairment (MCI) have multiple chronic conditions (MCC). The combination leads to multiple medications and complex medication regimens and is associated with increased risk for significant treatment burden, adverse drug events, cognitive changes, hospitalization, and mortality. Optimizing medications through deprescribing (the process of reducing or stopping the use of inappropriate medications or medications unlikely to be beneficial) may improve outcomes for MCC patients with dementia or MCI. Methods With input from patients, family members, and clinicians, we developed and piloted a patient-centered, pragmatic intervention (OPTIMIZE) to educate and activate patients, family members, and primary care clinicians about deprescribing as part of optimal medication management for older adults with dementia or MCI and MCC. The clinic-based intervention targets patients on 5 or more medications, their family members, and their primary care clinicians using a pragmatic, cluster-randomized design at Kaiser Permanente Colorado. The intervention has two components: a patient/ family component focused on education and activation about the potential value of deprescribing, and a clinician component focused on increasing clinician awareness about options and processes for deprescribing. Primary outcomes are total number of chronic medications and total number of potentially inappropriate medications (PIMs). We estimate that approximately 2400 patients across 9 clinics will receive the intervention. A comparable number of patients from 9 other clinics will serve as wait-list controls. We have > 80% power to detect an average decrease of − 0.70 (< 1 medication). Secondary outcomes include the number of PIM starts, dose reductions for selected PIMs (benzodiazepines, opiates, and antipsychotics), rates of adverse drug events (falls, hemorrhagic events, and hypoglycemic events), ability to perform activities of daily living, and skilled nursing facility, hospital, and emergency department admissions. Discussion The OPTIMIZE trial will examine whether a primary care-based, patient- and family-centered intervention educating patients, family members, and clinicians about deprescribing reduces numbers of chronic medications and PIMs for older adults with dementia or MCI and MCC. Trial registration NCT03984396. Registered on 13 June 2019
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Affiliation(s)
- E A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA. .,Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - S M Shetterly
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - M L Drace
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - J Norton
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A R Green
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.,Geriatric Medicine Research, Faculty of Medicine, and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - L A Weffald
- Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA
| | - L Wright
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - M L Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - O C Sheehan
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J L Wolff
- School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - K S Gleason
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - C Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - M Maiyani
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - M Du Vall
- Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA
| | - C M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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