Drug Use
Conditions
Keywords
Clinical pharmacist, Elderly, Adherence, Drug-related readmission
Brief summary
This randomized controlled trial primarily investigates if a clinical pharmacist intervention can reduce drug-related readmissions among patients \>75 years. The intervention targets the transfer between hospital and primary care. In brief, the intervention includes medical chart reviews and patient interviews during a period of 180 days.
Detailed description
At discharge from the hospital, patients that meet the inclusion criteria are offered to participate in the study. At this point the investigators will also gather baseline data through questionnaires on self-reported adherence (MARS-5) and quality of life (EQ-5D). The participants are randomized to the different study arms according to a stratified procedure based on their cognitive function. The intervention group will have their charts reviewed every second week and be contacted by the clinical pharmacist through phone within 7 and after 30 and 60 days respectively to discuss their medications. If possible drug-related problems are suspected during the interviews that cannot be solved immediately, the physician is contacted. Both groups have a follow-up time of 30 and 180 days. After 30 and 180 days, the patients will once again report adherence and quality of life. All other data can be gathered from the medical charts.
Interventions
OTHEREnhanced clinical pharmacist service
The intervention includes regular medical chart reviews, multiple patient interviews and, if needed, collaboration with the primary care physician.
Sponsors
Umeå University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Masking description
A group of physicians and clinical pharmacists will asses whether readmissions are drug-related or not. This group is blinded.
Eligibility
Sex/Gender
ALL
Age
75 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Living at home * Acutely admitted * Registered at one of ten pre-specified primary care health centers
Exclusion criteria
* Patients unable to communicate or who do not speak Swedish * Patients scheduled for palliative care * Patients admitted due to intoxication by alcohol or drug (non prescription)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time from discharge to first drug-related readmission | 180 days | Survival analysis with drug-related readmission as endpoint |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Frequency of drug-related readmissions | 30 and 180 days | Difference in total number of drug-related readmissions |
| Time from discharge to first drug-related readmission - subgroups with/without heart failure | 30 and 180 days | Survival analysis among patients with/without heart failure |
| Time from discharge to first drug-related readmission - subgroups with/without cognitive impairment | 30 and 180 days | Survival analysis among patients with/without cognitive impairment |
| Frequency of drug-related readmissions - subgroups with/without cognitive impairment | 30 and 180 days | Subgroup analysis among patients with/without cognitive impairment |
| Frequency of drug-related readmissions - subgroups with/without heart failure | 30 and 180 days | Subgroup analysis among patients with/without heart failure |
| Time from discharge to first all-cause hospital visit | 30 and 180 days | Survival analysis with readmission or visit to the emergency department as endpoint |
| Time from discharge to first drug-related readmission | 30 days | Survival analysis with drug-related readmission as endpoint |
| Self-reported adherence | 30 and 180 days | Adherence to medications reported through MARS-5 ( Medication Adherence Rating Scale) and Swedish Prescribed Drug Register |
| Self assessed quality of life: EQ-5D-questionnaire | 30 and 180 days | Health-related quality of life reported through the EQ-5D-questionnaire |
| Health economics | 180 days | Cost for visits for (drug-related) readmissions and to visits to the Emergency Department compared between patients in the control group and intervention group. |
| Medication appropriateness | 180 days | Medication appropriateness using the implicit Medication Appropriateness Index (MAI) and explicit tools in the form of the quality indicators published by the Swedish National Board of Health and Welfare and The European Union (EU)(7)-PIM list |
| Mortality | 30 and 180 days | Survival analysis with death as endpoint |
| Frequency of all-cause hospital visits | 30 and 180 days | Difference in total number of readmissions and visits to the emergency department |
Countries
Sweden
Contacts
Primary ContactKindstedt
Backup ContactMaria Gustafsson, Ph.D
Outcome results
None listed