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Trial registered on ANZCTR
Registration number
ACTRN12608000221358
Ethics application status
Approved
Date submitted
14/04/2008
Date registered
24/04/2008
Date last updated
25/08/2017
Type of registration
Prospectively registered
Titles & IDs
Public title
Community Pharmacy promoting appropriate sedative use in Aged Care: the "RedUSe"project
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Scientific title
The effect of Community Pharmacy co-ordinated training, feedback and case conferences on the prevalence rate of benzodiazepine and antipsychotic drug use in residential aged care facilities.
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Secondary ID [1]
292744
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nil known
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Universal Trial Number (UTN)
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Trial acronym
RedUSe (Reducing Use of Sedatives)
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Sedative use in residential aged care facilities. Sedatives are classified for the purposes of this study as antipsychotic, anxiolytic and hypnotic drugs. The majority of anxiolytic and hypnotic dugs are benzodiazepines.
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Condition category
Condition code
Mental Health
3203
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0
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Other mental health disorders
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Public Health
3204
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0
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Health promotion/education
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
1. Academic detailing – the research team will present a brief evidence-based educational session on appropriate use of sedatives to General practitioners (GPs) servicing residential aged care facilities (RACFs). This detailing will be conducted in the first three months of the project.
2. Case conferencing at residential aged care facilities. This intervention is part of the "enhanced care initiative" for GPs and involves co-ordinating a meeting between nursing staff, GP, pharmacist and resident or their relatives to discuss sedative management. It is estimated that one hundred case conferences will be conducted during the trial duration.
3. Drug Use Evaluation (DUE) - This intervention is similar to a clinical audit of prescribing, and involves individual measurement of sedative use at each RACF for presentation back to the nursing staff at the facility. Three DUE cycles will be completed; however feedback will be given to the nursing facility at baseline and at three months post-intervention.
4. Nursing home staff training - will be conducted by pharmacists and incorporate the results of the DUE and education regarding appropriate use and review of sedatives. Training is already recommended to be supplied by each community pharmacy supplying nursing homes. Two training sessions will be delivered to available nursing staff members throughout the six month duration of the trial.
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Intervention code [1]
2825
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Other interventions
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Comparator / control treatment
drug use evaluation (DUE)- The drugs evaluated will be antipsychotics and benzodiazepines. The DUE will be collected via a computer program using a data mining technique from pharmacy drug supply records at the pharmacy. This evaluation will be completed at each of the 24 residential aged care facilities. The DUE will be used to measure the sedative usage rates at each facility. the DUE measure will be completed at baseline, 12 weeks and 26 weeks post-intervention.
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Control group
Active
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Outcomes
Primary outcome [1]
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Prevalence rate of benzodiazepines and antipsychotics. This rate will be the percentage of residents prescibed antipsychotics in each facility, and the percentage of residents prescribed benzodiazepines in each home.
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Assessment method [1]
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Timepoint [1]
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baseline, 3 months and six months
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Secondary outcome [1]
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rate of dose alteration of antipsychotics and benzodiazepines
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Assessment method [1]
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Timepoint [1]
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baseline, 3 months and six months
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Secondary outcome [2]
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Prevalence rate of antidepressants. This rate will be the percentage of residents prescribed antidepressant treatment in the facility.
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Assessment method [2]
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Timepoint [2]
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baseline, 3 months and six months
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Secondary outcome [3]
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Acceptibility of intervention for participants. We will be conducting a series of focus groups to assess this measure. The first will involve consenting residents and enduring guardians/persons responsible. Another focus group will involve nursing staff, pharmacists and GPs to assess acceptibility of the set of interventions for health professionals.
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Assessment method [3]
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Timepoint [3]
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post intervention analysis
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Eligibility
Key inclusion criteria
Residential Aged Care Facilities - All residential aged care facilities within the metopolitan areas of Hobart and launceston will be invited to participate in the study. Dementia-specific residential aged care facilities are exempt.
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Minimum age
No limit
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
The psychotropic prevalence rates of the Residenitial Aged Care Facility will be studied as a whole. All residents will be included. Dementia-specific residential aged care facilities are expempt
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Study design
Purpose of the study
Educational / counselling / training
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
All Residential Aged Care Facilities (RACFs) in Hobart and launceston will be invited to particpate in ReDUSe. Twelve RACFs will be selected for the intervention after their supply pharmacy aggrees to participate. Control RACFs will be matched to the intervention homes after their community pharmacy agrees to participate.
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/07/2008
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Actual
24/07/2008
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Date of last participant enrolment
Anticipated
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Actual
1/03/2009
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Date of last data collection
Anticipated
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Actual
1/03/2009
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Sample size
Target
24
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Accrual to date
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Final
25
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Recruitment in Australia
Recruitment state(s)
TAS
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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Department of Health and Ageing
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Address [1]
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Canberra ACT
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Country [1]
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Australia
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Primary sponsor type
Charities/Societies/Foundations
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Name
The Pharmacy Guild of Australia
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Address
Research and Development program manager, Pharmacy Guild of Australia, PO Box 7036
Canberra business centre ACT 2610
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Country
Australia
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Secondary sponsor category [1]
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University
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Name [1]
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University of Tasmania
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Address [1]
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UMORE
The School of Pharmacy
University of Tasmania
Hobart Tas 7001
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Country [1]
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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The tasmanian health and Medical Human Research Ethics Committee
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Ethics committee address [1]
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Office of Research Services, University of Tasmania, private bag 1, Hobart, Tasmania 7001
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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14/01/2008
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Approval date [1]
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14/04/2008
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Ethics approval number [1]
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H0009858
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Summary
Brief summary
Studies have consistently shown that the use of sedative medications in many residential aged care facilities is excessively high. These agents are associated with side effects such as falls, daytime drowsiness and confusion. The most effective interventions to reduce sedative prescribing involve all key staff in this setting, namely nurses, GPs and pharmacists. The Australian government has recommended that pharmacists become more involved in ensuring appropriate use of sedative medications. The strategies of Drug Usage Evaluation (DUE) cycles and nursing staff training are currently promoted; however, there has been limited training for community pharmacists to effectively deliver these strategies. There are also no co-ordinated DUE and staff training packages that target sedative prescribing in residential aged care. This project aims to develop, trial and evaluate a sustainable program [Residential care: Decreasing Use of Sedatives (‘ReDUSe’)], to address inappropriate sedative prescribing in residential aged care. The strategies that form the ReDUSe program will be co-ordinated by the community pharmacy supplying the aged care home and involve the accredited pharmacist.
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Trial website
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Trial related presentations / publications
1. Westbury, JL and Jackson, SL and Gee, PR and Peterson, GM, “An effective approach to decrease antipsychotic and benzodiazepine use in nursing homes: the RedUSe project”, International Psychogeriatrics: The Official Journal of The International Psychogeriatric Association, 22 (1) pp. 26-36. doi:10.1017/S1041610209991128 2. Westbury, J and Tichleaar, L* and Peterson, G and Gee, P and Jackson, S, “A 12-month follow-up study of 'RedUSe': a trial aimed at reducing antipsychotic and benzodiazepine use in nursing homes”, International Psychogeriatrics: The Official Journal of The Interntional Psychogeriatric Association, 23 (8) pp. 1260-1269. doi:10.1017/S1041610211000421
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Public notes
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Contacts
Principal investigator
Name
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Dr Juanita Westbury
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Address
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wicking dementia research and education centre
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Country
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Australia
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Phone
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03 62261966
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Professor Gregory Peterson
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Address
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UMORE,
School of Pharmacy
University of Tasmania
Hobart tas 7001
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Country
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Australia
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Phone
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03 6226 2197
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Mrs Juanita Westbury
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Address
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UMORE, School of Pharmacy
University of Tasmania
Hobart tas 7001
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Country
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Australia
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Phone
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6226 1966
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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