Drug-Related Side Effects and Adverse Reactions
Conditions
Keywords
Older patients, Inappropriate prescribing, Clinical pharmacy
Brief summary
A randomized controlled trial will be performed in geriatric inpatients to investigate the impact of a multifaceted clinical pharmacy intervention on health related outcomes.
Detailed description
Since drug-related harm remains persistently prevalent in older adults, there is an urgent and unmet clinical need to optimize pharmacotherapy both during hospital stay and after discharge Therefore, we aim to perform a randomized controlled trial in geriatric inpatients to investigate the impact of a multifaceted clinical pharmacy intervention on health related outcomes. The primary objective is to reduce all-cause unplanned hospital visits in geriatric inpatients. Secondary objective are to optimize drug therapy in geriatric inpatients and improve their health; To empower and educate patients, caregivers,community pharmacists and physicians regarding drug regimen decisions to maximize therapy adherence and the understanding of the (de)prescribing process and to enhance healthy ageing; To optimize transitional care from the hospital to primary care.
Interventions
OTHERMultifaceted clinical pharmacy intervention
1. Assessing patient and caregiver preferences 2. Medication reconciliation on admission 3. Performing a comprehensive medication review before discharge 4. Promoting safe transition 4.a. Compiling a patient friendly medication list 4.b.Optimizing communication with healthcare providers in primary care: 4.b.i.Providing a copy of the medication list for the community pharmacist 4.b.ii. Contacting the general practitioner by phone 4.b.iii. Contacting, if applicable the home care nurse or the nurse from the nursing home by phone. 5.A motivation interview will take place before discharge with patients and caregivers 6.Post-discharge follow-up: 6.a.Follow-up call to discuss potential drug therapy issues, therapy adherence and to resolve any pending issues 6.b.A telepharmacology service will be provided to primary healthcare professionals as a means to consult the ward-based clinical pharmacists and/or research team after discharge.
Sponsors
Universitaire Ziekenhuizen KU Leuven
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Intervention model description
Randomized controlled trial
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Patients admitted to one of the study wards under supervision of a geriatrician * A written informed consent by the patient or his/her representative * Discharged from the hospital
Exclusion criteria
* Admitted for a maximum of one day * Unable to understand Dutch * Being in a palliative stage as stated in their medical record with active withdrawal of drug therapy * Patients being discharged to another ward within the same hospital or to another hospital
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to all-cause unplanned hospital visit after discharge. | up to six months after discharge | An unplanned hospital visit is defined as an unplanned hospital admission or an emergency department visit |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mortality | Up to six months after discharge | Death date |
| Other types of hospital visits | Up to six months after discharge | Number of planned hospital admissions, number of emergency department visits, number of unplanned hospital admissions |
| Drug-related readmissions | Up to six months after discharge | Number of drug related readmissions |
| Fall incidents | Up to one month after discharge | Number of falls |
| Patient reported drug related problems | Up to one month after discharge | Number of drug related problems |
| General practitioners contacts | Up to six months after discharge | Number of general practitioners contacts |
| Differences in pain | Up to one month after discharge | Numeric Rating Scale (NRS score) once a week (min 0 - max 10), a higher score indicating more pain |
| Medications | On admission, at discharge and one month after discharge | Number of medications |
| Medication adherence | On admission and one month after discharge | BAASIS tool |
| Potentially inappropriate medications | On admission, at discharge and one month after discharge | RASP tool |
| Cost-effectiveness | Up to six months after discharge | Healthcare related costs and Medicine productivity costs |
| Change in Quality of life | on admission, one month after discharge and six months after discharge | five-level version of the EuroQol five-dimensional (EQ5D) descriptive system (EQ-5D-5L) questionnaire. values will be tranformed using a value set to a score from 0 - 1 (a higher score indicating a better quality of life) |
Countries
Belgium
Outcome results
None listed