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Thursday, Sep. 22, 2016, 8:48 AM
by Kristin Smart
Vanderbilt University Medical (VUMC) researchers have received a $2.9 million federal grant to test the effectiveness of a new intervention that aims to help older patients reduce the number of medications they may be taking on a regular basis.
A clinical trial of the intervention, known as “Shed-Meds,” will be conducted at VUMC and 14 area skilled nursing facilities, with plans calling for enrolling approximately 1,300 participants over five years.
Funded by the National Institutes of Health and Aging, the trial seeks to evaluate the Shed-Meds intervention in addressing polypharmacy — the use of five or more medications by people age 65 and older.
“Polypharmacy is definitely one of the most common problems that we see that we rarely intervene upon — if anything we often add to the problem instead of reducing it. So, I think it is a great opportunity for hospitalists to focus on this area,” said Eduard Vasilevskis, M.D., assistant professor of Medicine and co-principal investigator on the grant.
Shed-Meds will target not just medical or surgical patients, but all patients 65 years and older who take a minimum of five medications and who are discharged to a skilled nursing facility. Researchers have pilot-tested the patient-centered intervention with promising results.
“I think from the patient standpoint it could really simplify and hopefully improve their medication burden and help their adherence, help them be more capable of managing their medications on their own once they leave the hospital and hopefully leave the skilled nursing facility and discharge back home,” said Sandra Simmons, Ph.D., assistant professor of Medicine and co-principal investigator.
Prior studies show these same patients can have a host of geriatric syndromes — such as unintentional weight loss, recurrent falls, depression, chronic pain and incontinence — and the multiple medications they are taking could be contributing to those syndromes, according to Simmons.
“I think it’s important that we remind our patients, as well as our providers, that the whole goal is to really understand, if we reduce medicines does it actually benefit people’s health? I think that some people might believe that fewer medications must be good, and that’s not necessarily the case,” Vasilevskis said.
“Hopefully at the end of this study we have a really good understanding of what were the most challenging classes of medications to stop or titrate? What were the most common barriers? What were the things that helped make the intervention more successful? This knowledge will help us understand how to make the intervention, if successful, part of routine hospital practice on a more broad scale,” Simmons said.
Starting this month, Simmons and Vasilevskis will begin assembling their Shed-Meds team and creating protocols. Recruitment of study participants will start in the first half of 2017.
The 14 skilled nursing facilities involved in the clinical trial are based in Davidson, Williamson and Rutherford counties.
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