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Inskip M, Almendrales Rangel C, Njoku CM, Barnett F, Shih I, O’Neill L, Fiatarone Singh MA, Valenzuela T. The Frailty Reduction via Implementation of Exercise, Nutrition, and Deprescribing (FRIEND) Trial: Study Protocol and Recruitment Results. Methods Protoc 2024; 7:26. [PMID: 38525784 PMCID: PMC10961770 DOI: 10.3390/mps7020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024] Open
Abstract
INTRODUCTION Virtually all adults in aged care facilities are frail, a condition which contributes to falls, cognitive decline, hospitalisation, and mortality. Polypharmacy, malnutrition, sedentariness, and sarcopenia are risk factors amenable to intervention. The Asia-Pacific Frailty Management Guidelines recommend anabolic exercise and the optimisation of medications and nutrition. However, no study has evaluated this best practice intervention triad in aged care. METHODS The Frailty Reduction via the Implementation of Exercise, Nutrition, and Deprescribing (FRIEND) Trial (ANZCTR No.ACTRN12622000926730p) is a staged 6-month translational trial evaluating resident outcomes, staff/caregiver knowledge, and institutional implementation in a Townsville aged care facility. Residents received high-intensity resistance exercise and balance training and medication and nutrition optimisation co-implemented by investigators (exercise physiologist, geriatrician, pharmacist, and nutritionist) and facility staff. Staff and caregivers completed comprehensive education modules and training. We report the trial protocol and recruitment results. RESULTS 29 residents (21 female, age: 88.6 ± 6.3 years) were recruited. At baseline, the residents were frail (frailty scale nursing home (FRAIL-NH); 6.3 ± 2.4/14), cognitively impaired (Montreal Cognitive Assessment; 13.8 ± 6.8/30), functionally impaired (Short Physical Performance Battery; 4.9 ± 3.1/12, 6 min walk distance; 222.2 ± 104.4 m), and were prescribed numerous medications (15.5 ± 5.9). Two residents died and one withdrew before the intervention's commencement. Thirty family members and 19 staff (carers, allied health assistants, nurse managers, registered nurses, lifestyle-leisure officers, kitchen/hospitality staff, and senior leadership) were recruited to receive frailty education modules. CONCLUSIONS The FRIEND trial is currently being implemented with results expected in mid-2024. This is the first trial to evaluate the implementation of the best practice frailty guidelines including anabolic exercise and medication/nutritional optimisation in residential aged care.
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Affiliation(s)
- Michael Inskip
- College of Healthcare Sciences, James Cook University, Townsville, QLD 4814, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Carolina Almendrales Rangel
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | | | - Fiona Barnett
- College of Healthcare Sciences, James Cook University, Townsville, QLD 4814, Australia
| | - Isabel Shih
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | | | - Maria A. Fiatarone Singh
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
- The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA 02131, USA
| | - Trinidad Valenzuela
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7550196, Chile
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Whitfield K, Coombes I, Denaro C, Donovan P. Medication Utilisation Program, Quality Improvement and Research Pharmacist-Implementation Strategies and Preliminary Findings. Pharmacy (Basel) 2021; 9:pharmacy9040182. [PMID: 34842809 PMCID: PMC8628968 DOI: 10.3390/pharmacy9040182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022] Open
Abstract
Judicious use of medicines that considers evidence-based practice, together with cost-effectiveness, is a priority for all health care organisations. We describe an initiative to lead a Medication Utilisation Program, incorporating medication quality improvement and research activities. In August 2020 an advanced pharmacist position was implemented to lead the Program. The purpose was to provide oversight and facilitate initiatives promoting medication optimisation to create sustainable change in practice. A strategic plan was developed with key performance indicators. A governance structure was implemented with relevant reporting mechanisms. Strategic planning and collaboration with medical, nursing and allied health professionals has seen the successful implementation of seven codesigned medication-use evaluations and eight quality improvement projects centred around patient safety, quality and value-based care. Several research studies have been designed with subsequent commencement of pharmacists enrolled in university Research Higher Degree programs. Cost containment initiatives have realised potential savings approximating AUD 250,000. Educational programs included protocol design, ethics approvals and report writing. Key success criteria for a Medication Utilisation Program include dedicated pharmacist resources, structured governance and reporting mechanisms. Alignment of study complexity with staff experience and interdisciplinary collaboration are also critical.
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Affiliation(s)
- Karen Whitfield
- Department of Clinical Pharmacology, Royal Brisbane and Women’s Hospital, Butterfield Street Herston, Brisbane, QLD 4029, Australia;
- School of Pharmacy, University of Queensland, 20 Cornwall Street, Brisbane, QLD 4102, Australia;
- Correspondence:
| | - Ian Coombes
- School of Pharmacy, University of Queensland, 20 Cornwall Street, Brisbane, QLD 4102, Australia;
- Department of Pharmacy, Royal Brisbane and Women’s Hospital, Butterfield Street Herston, Brisbane, QLD 4029, Australia
| | - Charles Denaro
- Department of Internal Medicine & Aged Care, Royal Brisbane and Women’s Hospital, Butterfield Street Herston, Brisbane, QLD 4029, Australia;
- Faculty of Medicine, University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia
| | - Peter Donovan
- Department of Clinical Pharmacology, Royal Brisbane and Women’s Hospital, Butterfield Street Herston, Brisbane, QLD 4029, Australia;
- Faculty of Medicine, University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia
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Sheehan R, Strydom A, Marston L, Morant N, Fiori F, Santosh P, Hassiotis A. A structured medication review tool to promote psychotropic medication optimisation for adults with intellectual disability: feasibility study. BMJ Open 2019; 9:e033827. [PMID: 31843854 PMCID: PMC6924735 DOI: 10.1136/bmjopen-2019-033827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate the feasibility of delivering structured psychotropic medication review in community services for adults with intellectual disability (ID). DESIGN Single-arm feasibility study conducted over a 6-month period. SETTING Specialist community ID teams in England. PARTICIPANTS Psychiatrists working with adults with ID and adults with ID who had been prescribed psychotropic medication. INTERVENTION A structured web-based psychotropic medication review tool (the HealthTracker-based structured medication review) comprising measures of therapeutic benefit and adverse side-effects was made available for use by psychiatrists in routine clinic appointments. A summary measure of medication effectiveness was graphically presented to aid discussion and decision-making. MAIN OUTCOME MEASURES Feasibility metrics including number of people with ID referred, eligible and recruited, and uptake of the medication review tool in naturalistic clinical settings. Psychiatrist and patient feedback was collected to assess acceptability of the intervention and suggestions for development. RESULTS Fifteen psychiatrists from five clinical teams took part. In total 94 potentially eligible people with ID were referred, of whom 79 (84%) were recruited and together underwent 97 medication reviews over the 6-month study period. Feedback from participants with ID was favourable. Psychiatrists indicated that the HealthTracker-based structured medication review was broadly acceptable and suggested adaptations to improve integration with existing information technology systems and to enhance patient involvement in the review. CONCLUSIONS Structured psychotropic medication review can be used in community services for adults with ID as part of a programme of medication optimisation. It would be feasible to test clinical and patient outcomes of the HealthTracker-based medication review in a randomised clinical trial.
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Affiliation(s)
- Rory Sheehan
- Division of Psychiatry, University College London, London, UK
| | - André Strydom
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Federico Fiori
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
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