Health Services for the Aged, Medication Therapy Management
Conditions
Brief summary
Suboptimal use of medications among geriatric patients is well-known problem and leads to medication errors, re-hospitalizations and death. By using a randomized controlled trial (RCT) design the investigators aim to explore a new inter-professional working structure. The working structure is based on the scientifically and clinically acknowledged integrated medicines management (IMM) model. The overall aim of the study is to explore the effect of the new working structure on the composite endpoint re-hospitalization + visit to an emergency department during 12 months after hospital discharge.
Interventions
OTHERInterdisciplinary collaboration structure
A pharmacist is integrated in the team surrounding the patient, working by the Integrated Medicines Management (IMM) model. The IMM-model consist of medication reconciliation, medication review, standardized medication reports and counseling patients about their medication at discharge. In addition a phone meeting between the primary care physician and the study pharmacist is added after discharge.
Sponsors
University Hospital of North Norway
University of Tromso
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
70 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Aged ≥70 years * Admitted to the geriatric internal medicine ward in the University Hospital of North Norway (UNN) Tromsø or the general internal medicine ward in UNN Harstad. * Willing to provide written informed consent during hospital stay (patient or next of kin)
Exclusion criteria
* Unable to communicate in Norwegian (patient or next of kind) * Terminally ill, e.g cancer in end-life stage * Control group patients where the physician request an assessment from a pharmacist * Time from admittance to the ward to inclusion is more than 72 hours * Occupying a bed in the study wards but under the care of physicians from a non-study ward. * Planned discharged on the inclusion day
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Emergency medical visits | 12 months after hospital discharge | Rate of emergency Medical visits at 12 months. Emergency Medical visits is a composite endpoint including emergency department visits and unscheduled hospitalization |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Self-reported quality of life | 1 months after hospital discharge | Change in self-reported quality of life using the validated EQ-5D |
| length in days of index hospital stay | Days from hospitalization to discharge of index hospital stay, assessed up to 12 months | Days from hospital admission to discharge of index hospital stay |
| Time to first rehospitalization | First rehospitalization after discharge from index hospital stay, up to 12 months after discharge. | Days to first hospitalization |
| Visits to primary care physician | 12 months after discharge for index hospital stay | Visitation rate at 12 months |
| Mortality rate | 12 months after randomization | — |
| Total score of the Medication appropriateness index (MAI) | Baseline at randomization | — |
| Change in total score of the Medication appropriateness index (MAI) | From baseline to date of discharge from hospital, assessed up to 12 months | — |
| Inappropriate medications identified through the Norwegian general practice criteria (NORGEP) | Baseline at randomization | — |
| Change in Inappropriate medications identified through the Norwegian general practice criteria (NORGEP) | From baseline to date of discharge from hospital, assessed up to 12 months | — |
| Potentially inappropriate prescribing identified through the Screening Tool to Alert doctors to Right treatment (START) | Baseline at randomization | — |
| Change in potentially inappropriate prescribing identified through the Screening Tool to Alert doctors to Right treatment (START) | From baseline to date of discharge from hospital, assessed up to 12 months | — |
| Potentially inappropriate prescribing identified through the Screening Tool of Older Persons' Prescriptions (STOPP) | Baseline at randomization | — |
| Change in potentially inappropriate prescribing identified through the Screening Tool of Older Persons' Prescriptions (STOPP) | From baseline to date of discharge from hospital, assessed up to 12 months | — |
| Changes in medication, identified through screening of drug lists at their primary care physician. | 12 months after discharge from index hospital stay | Drug changes made during hospitalization implemented by the primary care physician. |
| Rehospitalizations where the reason for hospitalization is possibly, probably or certainly drug-related. | First rehospitalization after discharge from index hospital stay, up to 12 months after inclusion in study | A chart review will be done retrospectively to evaluate if the patients first rehospitalization was drug related or not. Classified by a multiprofessional team of experts |
| Hip fracture | 12 months after discharge from index hospital stay | Rate of hip fractures |
| Stroke | 12 months after discharge from index hospital stay | Stroke rate during 12 months follow-up |
| The proportion of patients readmitted acutely within 30 days | 30 days after discharge from index hospital stay | — |
| Change in inappropriate medications identified through the Norwegian general practice criteria (NORGEP) | From baseline to 3 months after discharge from index hospital stay, assessed up to 12 months | — |
Countries
Norway
Outcome results
None listed