D-MED
De-intensifying Medications Study
Study title
Many older people suffer from frailty, characterised by a decline in both their physical and mental health and a number of health conditions requiring treatment. In type 2 diabetes, managing frailty means striking a balance to prevent overtreatment with some diabetes medications which increase the risk of low blood sugar and lead to more falls, fractures and deaths.
Background
The aim of this study is to help clinical practice staff with prescribing responsibilities to reduce the proportion of potentially inappropriate diabetes medications prescribed in older people (aged 65 years and over) with type 2 diabetes and frailty. Managing medication for this group of patients is complex and they often require multiple medications. Reducing unnecessary diabetes medication prescriptions may prevent the adverse treatment effects associated with overtreatment. This may also reduce unnecessary prescription costs. This study is investigating an intervention involving an electronic decision-support system, accompanied by clinical training, follow-up support and performance review, designed to support practice staff to reduce potentially inappropriate diabetes medications in a primary care setting.
Study aims
Who can participate?
GP practices (4000 to 12,000) within three or four different English regions that use either EMIS Web or SystmOne clinical database systems and have categorised their older patients with type 2 diabetes with the electronic frailty index (eFI) in line with the Quality Outcomes Framework (QOF)
What does the study involve?
All practices will be asked to participate in the export of study data at the beginning of the study and again at 6 and 12 months. GP practices are randomly allocated to an intervention or control group. Practices in the control group will continue with ‘usual’ care for their patients and will not have to participate in any other activities. Practices in the intervention group will be asked to undertake the following activities. An electronic decision-support system will be remotely installed on the practice IT system for 12 months to facilitate the identification and management of old er frail people with type 2 diabetes. This software will allow practice staff to run a search to generate a list of potential patients for a medication review and it will also generate automatic screen alerts when patients, who are potentially eligible for medication review, attend an appointment. Criteria used to identify these patients will include their age, diagnoses, most recent HbA1c result, their prescribed medications and their electronic Frailty Index (eFI) score. Training on how to use this system will be delivered as part of a webinar training session for intervention practices. At least two members of the practice clinical team with responsibility for managing prescriptions for older patients with type 2 diabetes (for example a practice nurse with prescribing rights, a general practitioner or a practice clinical pharmacist where there is one) will be asked to complete a webinar training session with a clinical advisor. This will take about 1 hour and will upskill the clinicians in the management of this high-risk patient group - learning when and how to safely reduce, stop or switch diabetes medications. Additionally, each intervention practice will have access to email support, short online booster-training sessions and will receive a 3-month performance review with a clinical advisor. A clinical advisor will also contact the practice on a monthly basis to monitor patient safety and discuss any issues or concerns.
Study summary
Study progress
Recruitment due to start Oct/Nov 2021
The National Institute for Health Research Applied Research Collaboration East Midlands (NIHR ARC-EM) (UK)
Funding and sponsorship
None yet
Study publications
Principle investigator: Dr Samuel Seidu, sis11@leicester.ac.uk