What is the effect of a structured medication discontinuation clinical pathway designed to reduce polypharmacy on mean number of medications and patterns of discontinuation compared to usual practice?
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Reduction in mean number of medications
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Mean number of medications (primary outcome)
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T0, T6
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Linear regression
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Proportion of participants with successful reduction in medication number or dose
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T6
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Logistic regression
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Composite variable of mean number of medication discontinuations and/or dose reductions
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T6
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Linear regression
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What is the effect of a structured medication discontinuation clinical pathway designed to reduce polypharmacy on patient quality of life, cognition, mobility-related fatigue, nutritional status, physical function capacity, pain, sleep, patient enablement, medication self-efficacy, medication confusion, grip strength, falls and adverse events, and hospital admissions compared to usual practice?
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Improved disease and treatment burden, quality of life, cognition, fatigue, nutritional status, physical function capacity and ability, pain, sleep, patient enablement, medication self-efficacy and lower/fewer falls, healthcare utilization, and adverse events will be reported in the intervention arm compared to the control arm at 6-months
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Disease burden
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T0, T6
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Linear regression
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Treatment burden
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T0, T6
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Linear regression
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Quality of life
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T0, T6
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Linear regression for all continuous outcomes, Logistic regression for Categorical outcomes and Count data models (e.g., Poisson/negative binomial regression, zero-inflated models) for count outcomes
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T0, T6
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Cognition
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T0, T6
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Fatigue
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T0, T6
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Nutritional status
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T0, T6
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Physical function capacity and ability
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T0, T6
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T0, T6
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T0, T6
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T0, T6
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Number of Falls
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T0, T6
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Pain
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T0, T6
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Sleep
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T0, T6
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Patient enablement
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T0, T6
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Medication self-efficacy
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T0, T6
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Healthcare resource utilization (number of hospitalizations, emergency department visits, primary care visits, proportion of patients with at least one hospitalizations)
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T0, T6
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T0, T6
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T0, T6
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T0, T6
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Number of Serious adverse events and beneficial withdrawal
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T1, T3, T6
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What is the cost-effectiveness of the structured medication discontinuation clinical pathway designed to reduce polypharmacy?
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Not applicable
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Cost per QALY
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T6
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Cost utility analysis
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What is the experience of patients as they go through a structured medication discontinuation clinical pathway designed to reduce polypharmacy?
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Not applicable
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Lived experience with deprescribing process
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T6
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Descriptive analysis of Semi-structured interview/patient diaries
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Satisfaction with the intervention (5-point Likert scale)
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T6
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Descriptive statistics (M, SD)
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Satisfaction with care around medications (5-point Likert scale)
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T0, T6
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Linear regression
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Strengths and weaknesses of intervention
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T6
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Descriptive analysis
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What are the experiences of the pharmacist and family physician of managing patients through the deprescribing process?
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Not applicable
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Lived experience with deprescribing process
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T6
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Thematic analysis of semi-structured interviews/field notes
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Confidence in medication discontinuation (5-point Likert scale)
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T0, T6
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Linear regression
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Five best/worst aspects of intervention
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T6
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Descriptive analysis
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Implementation processes
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Early/late implementation
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Descriptive analysis
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