Objectives: Deprescribing has gained awareness recently, but the clinical benefits observed from randomized trials are limited. The aim of this study was to examine the effectiveness of a pharmacist-led 5-step team-care deprescribing intervention in nursing homes to reduce falls (fall risks and fall rates). Secondary aims include reducing mortality, number of hospitalized residents, pill burden, medication cost, and assessing the deprescribing acceptance rate. Design: Pragmatic multicenter stepped-wedge cluster randomized controlled trial. Setting and Participants: Residents across 4 nursing homes in Singapore were included if they were aged 65 years and above, and taking 5 or more medications. Methods: The intervention involved a 5-step deprescribing intervention, which involved a multidisciplinary team-care medication review with pharmacists, physicians, and nurses (in which pharmacists discussed with other team members the feasibility of deprescribing and implementation using the Beers and STOPP criteria) or to an active waitlist control for the first 3 months. Results: Two hundred ninety-five residents from 4 nursing homes participated in the study from February 2017 to March 2018. At 6 months, the deprescribing intervention did not reduce falls. Subgroup analysis showed that intervention reduced fall risk scores within the deprescribing-naïve group by 0.18 (P ¼ .04). Intervention was associated with a reduction in mortality [hazard ratio (HR) 0.16, 95% confidence interval 0.07, 0.41; P < .001] and number of hospitalized residents (HR 0.16, 95% CI 0.10, 0.26; P < .001). Pre-post analysis witnessed a reduction in pill burden at the end of the study, and a conservative daily cost saving estimate of US$11.42 (SG$15.65) for the study population. Approximately threequarters of deprescribing interventions initiated by the pharmacists were accepted by the physicians. Conclusions and Implications: Multidisciplinary medication reviewedirected deprescribing was associated with reductions in mortality and number of hospitalized residents in nursing homes and should be considered for all nursing home residents.Ó 2020 AMDA e The Society for Post-Acute and Long-Term Care Medicine.Polypharmacy, or the concurrent use of multiple medications, is common among nursing home residents, which heightened the risk of using potentially inappropriate medication (PIM). 1 A recent systematic review found that about half of older nursing home residents were exposed to PIM, which can lead to greater incidences of adverse events. 2 Adverse outcomes such as fall risks 3 and falls 4 were associated with the use of polypharmacy, particularly when fall The authors declare no conflicts of interest.

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IntroductionAn ageing population has become an urgent concern for Asia in recent times. In nursing homes, polypharmacy has also become a compounding issue. Deprescribing practice is an evidence-based strategy to provide a better outcome in this group of patients; however, its implementation in nursing homes is often challenging, and prospective outcome data on deprescribing practice in the elderly is lacking. Our study assesses the implementation of team-care deprescribing to understand the benefits of this practice in geriatric setting and to explore the factors affecting deprescribing practice.Methods and analysisThis multicentre prospective study consists of a prestudy interview questionnaire, and a preintervention and postintervention study to be conducted in the nursing home setting on residents at least 65 years old and on five or more medications. We will employ a cluster randomised stepped-wedge interventional design, based on a five-step (reviewing, checking, discussion, communication and documentation) team-care deprescribing practice coupled with the use of a deprescribing guide (consisting of Beers and STOPP criteria, as well as drug interaction checking), to assess the health and pharmacoeconomic outcome in nursing homes’ practice. Primary outcome measures of the intervention will consist of fall risks using a fall risk assessment tool. Other outcomes assessed include fall rates, pill burden including number of pills per day, number of doses per day and number of medications prescribed. Cost-related measures will include the use of cost–benefit analysis, which is calculated from the medication cost savings from deprescribing. For the prestudy interview questionnaire, findings will be analysed qualitatively using thematic analysis.Ethics and disseminationThis study is approved by the Domain Specific Review Board of National Healthcare Group, Singapore (2016/00422) and Monash University Human Research Ethics Committee (2016-1430-7791). The study findings shall be disseminated in international conferences and peer-reviewed publications. The study is registered with ClinicalTrials.gov (NCT02863341), Pre-results

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IntroductionEpidemiological studies have reported that diabetes‐related complications increase after 5 years of uncontrolled/suboptimal metabolic control. The risk of experiencing diabetes‐related microvascular diseases usually spike after 10 years of uncontrolled diabetes.ObjectivesThe objective of this study was to evaluate the impact of team‐based pharmaceutical care on glycemic control, self‐care, diabetes‐dependent quality of life, and productivity loss in patients with long‐standing diabetes (≥5 years).MethodsThis was a prospective, multicenter, randomized, controlled study. Patients with a glycosylated hemoglobin (HbA1c) > 7%, long‐standing diabetes defined as having a disease duration of at least 5 years, and polypharmacy defined as taking 5 or more chronic medications were included in the study. Patients in the intervention arm received team‐based pharmaceutical care regularly while patients in the control arm received physician‐centered care. Patients' humanistic outcomes were followed for 6 months.ResultsA total of 248 patients (126 intervention and 122 control) were included in the study. In addition to improved glycemic control observed in the intervention arm (mean difference: 0.44%, P = .003, 95% confidence interval: [0.15, 0.73]), the intervention arm showed significant improvements in overall self‐care level (+0.36, 95% confidence interval: [0.01, 0.72], P = .045) and self‐monitoring of blood glucose (+1.87, 95% confidence interval: [1.00, 2.99], P < .001) compared with the control arm. There were no significant differences in the changes in diabetes‐associated quality of life and overall work impairment between the two arms. A significant difference in activity impairment (affected productivity in regular unpaid activity) between the two arms was found, with 43.3% impairment having occurred in the control group vs 27.9% in the intervention group (P = .047).ConclusionTeam‐based pharmaceutical care significantly improved overall self‐care and glycemia without deteriorating quality of life and incurring productivity loss. Our findings highlighted the value of team‐based pharmaceutical care in managing diabetes‐experienced patients.