title: Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study): protocol of a cluster randomised controlled trial.
abstract: BACKGROUND
  Nursing home residents often have a high number of comorbidities resulting in polypharmacy. Inappropriate prescribing is therefore likely to occur, which in turn is expected to worsen cognitive impairment, to increase the fall risk and to decrease residents' quality of life. The objective of the 'Discontinuing Inappropriate Medication in Nursing Home Residents' (DIM-NHR) study is to examine the efficacy and cost-effectiveness of the Multidisciplinary Multistep Medication Review (3MR) that is aimed at optimising prescribing and discontinuing inappropriate medication.
  
  
  METHODS
  A cluster randomised controlled trial will be conducted. Elderly care physicians and their wards (clusters) will be randomised. Data will be collected at baseline and 4 months after the 3MR has taken place. Six hundred nursing home residents will be recruited of whom more than half are expected to suffer from dementia. The 3MR will be based on consensus criteria and the relevant literature and will be performed by the patient's elderly care physician in collaboration with a pharmacist.
  
  
  METHODS
  Primary outcomes-the difference in proportion of residents who successfully discontinued inappropriate medication between the intervention and control group at follow-up. Secondary outcomes-undertreatment, exposure to anticholinergic and sedative medicines, neuropsychiatric symptoms, cognitive function, falls, hospital admission, quality of life and cost-effectiveness.
  
  
  BACKGROUND
  Participant burden will be kept at a minimum. The elderly care physician will remain free to adjust medication when symptoms relapse or adverse events occur, rendering serious adverse events highly unlikely. Study findings will be published in peer-reviewed journals and a 3MR toolkit will be developed.
  
  
  BACKGROUND
  This study has been registered at http://www.ClinicalTrials.gov (trial registration number: NCT01876095).
authors.affiliation: Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Wouters
authors.affiliation: Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands.
authors.forename: Elise H
authors.initials: EH
authors.lastname: Quik
authors.affiliation: Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Froukje
authors.initials: F
authors.lastname: Boersma
authors.affiliation: Hospital Pharmacy, Diaconessenhuis, Meppel, The Netherlands.
authors.forename: Peder
authors.initials: P
authors.lastname: Nygård
authors.affiliation: Hospital Pharmacy, Diaconessenhuis, Meppel, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Bosman
authors.affiliation: Hospital Pharmacy, Diaconessenhuis, Meppel, The Netherlands.
authors.forename: Wendelien M
authors.initials: WM
authors.lastname: Böttger
authors.affiliation: Hospital Pharmacy, Wilhelmina Ziekenhuis Assen, Assen, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Mulder
authors.affiliation: Hospital Pharmacy, Diaconessenhuis, Meppel, The Netherlands.
authors.forename: Jan-Gerard
authors.initials: JG
authors.lastname: Maring
authors.affiliation: Department of Clinical Pharmacy and Toxicology, Martini Ziekenhuis Groningen, Groningen, The Netherlands.
authors.forename: Linda
authors.initials: L
authors.lastname: Wijma-Vos
authors.affiliation: Department of Clinical Pharmacy and Toxicology, Martini Ziekenhuis Groningen, Groningen, The Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Beerden
authors.affiliation: Department of Clinical Pharmacy and Toxicology, Martini Ziekenhuis Groningen, Groningen, The Netherlands.
authors.forename: Jasperien
authors.initials: J
authors.lastname: van Doormaal
authors.affiliation: Department of Pharmacy, Unit of Pharmaco-epidemiology and Pharmaco-economics, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
authors.affiliation: Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Sytse U
authors.initials: SU
authors.lastname: Zuidema
authors.affiliation: Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands.
authors.forename: Katja
authors.initials: K
authors.lastname: Taxis
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003704:Dementia; D018450:Disease Progression; D017723:Drug Utilization Review / Q000379:methods*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D057970:Inappropriate Prescribing / Q000191:economics / Q000517:prevention & control*; D009735:Nursing Homes; D019338:Polypharmacy; D058996:Quality Improvement; D011788:Quality of Life
chemical_list: D018680:Cholinergic Antagonists; D006993:Hypnotics and Sedatives
keywords: CLINICAL PHARMACOLOGY; GERIATRIC MEDICINE; HEALTH ECONOMICS; MEDICAL EDUCATION & TRAINING