Adverse Drug Reaction, Polypharmacy
Conditions
Keywords
Drug Utilization Review, Aged, Aged, 80 and over, Primary Health Care
Brief summary
The purpose of this study is to determine whether an educational intervention given towards health care providers working in primary health care centers can reduce inappropriate prescribing in the elderly patient and thus reduce number and length of drug-related hospitalizations as well as number of emergency department visits in this patient group.
Detailed description
Inappropriate medication in the elderly patient leads to substantial morbidity, possibly causing up to 20% of hospitalizations in this patient group (1). To improve prescribing and thus reduce undesired drug effects is a great challenge for doctors and nurses in primary health care. Performance of drug utilization reviews is recommended in order to reduce the negative impact of inappropriate prescribing in the elderly. However, scientific evidence on their efficacy is lacking, especially regarding patient-related health outcomes (2,3). Most studies are carried out in inpatient care, making it difficult to draw conclusions regarding primary health care (2). Moreover, studies in this scientific field diverge regarding the content and structure of drug utilization reviews, which implies that comparison between studies becomes challenging, if not impossible. This trial aims at educating health care providers in how to perform drug utilization reviews, and to help them implement theory into practice.
Interventions
OTHEREducational intervention
Primary health care centers (PHCC) in the intervention group will be visited twice by a pharmacist within a period of three months. At the first visit, an educational intervention will focus on two properties: on the one hand, feed-back of actual patient data of the PHCC illustrating the primary-health-care-specific characteristics of inappropriate prescribing in the elderly patient will be given. Education of relevant subjects will be given in relation to detected problems. On the other hand, a clinical routine regarding the performance of drug utilization reviews will be developed in cooperation with the health care providers. At the second visit 3 months later, the developed concept will be critically reviewed and eventually developed further.
Sponsors
Region Stockholm
Karolinska Institutet
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* primary health care center in Stockholm County * authorized by Stockholm County Council since at least 3 years * at least 5% of patients attributed to primary health care center are 65 years and older * primary health care center takes care of at least 10 home care patients
Exclusion criteria
* less than 3000 patients listed in primary health care center * primary health care centers where researchers carrying out the present study work
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Composite outcome: Unplanned hospitalisation or emergency department visit | 9 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Emergency department visit | 9 months | — |
| Length of hospital stay | 9 months | — |
| All cause mortality | 9 months | — |
| Number of drug utilization reviews | 9 months | — |
| Unplanned hospitalisation | 9 months | — |
| Inappropriate drug use according to national guidelines | 9 months | see link |
| Number of patients with contraindicated drugs regarding renal function | 9 months | — |
| Number of drugs with inappropriate drug dose regarding renal function | 9 months | — |
| Number of drug interactions | 9 months | — |
| Number of patients with polypharmacy | 9 months | polypharmacy: 5-9 drugs/patient excessive polypharmacy: 10 and more drugs/patient |
Countries
Sweden
Outcome results
None listed