Improving Medication Prescribing for Ontario’s Vulnerable Elderly High Cost Healthcare Users (IMPROVE-HCU)

Objectives: To evaluate the feasibility of conducting a large, well designed and appropriately powered randomized controlled trial to determine the effectiveness of a comprehensive medication optimization and deprescribing intervention in reducing re-hospitalization, mortality and healthcare expenditures for frail senior HCUs locally in the Hamilton Niagara Haldimand Brant (HNHB) LHIN and abroad.

Overview: IMPROVE-HCU is a multi-centre pilot randomized controlled trial of hospitalized general medicine HCUs aged ≥ 65 years at high risk of readmission in the HNHB LHIN. Patients will be randomized to receive usual care or a comprehensive medication optimization and deprescribing intervention that includes the clinical application of STOPP/START criteria with expert geriatric clinical pharmacology consultation and post-discharge telemedicine follow-up in a shared care model with primary care providers.

Impact and Value Proposition: IMPROVE-HCU will advance the efforts of stakeholders to improve healthcare sustainability and HCU health through the design of targeted interventions. The focus on medication quality for HCUs is unique and has not been examined internationally. If only 10% of drug or healthcare utilization expenses for senior HCUs could be avoided or delayed, an estimated $1.7 billion provincially and $100 million in our LHIN would be available annually to fund better care for these high-risk, high cost seniors.​

Principal Investigator: Justin Lee, BScPhm, ACPR, MD, FRCPC

IMPROVE-HCU Investigator Team:

  • Anne Holbrook, MD, PharmD, MSc, FRCPC
  • Alexandra Papaioannou, BScN, MD, MSc, FRCPC
  • Lisa Dolovich, BScPhm, PharmD, MSc
  • Dee Mangin, MBChB, DPH, FRNZCGP
  • Mitchell Levine, MD, MSc, FRCPC
  • Joanne Ho, MD, MSc, FRCPC
  • Christopher Patterson, MD, FRCPC
  • Dan Perri, BScPhm, MD, FRCPC
  • Lawrence Mbuagbaw, MD, PhD