Medication Adherence, Aging, Multidisciplinary Communication, Fall, Hospital Discharge
Conditions
Brief summary
Background and overall goal: Poor comprehension and medication adherence are common in older people, especially after hospitalizations, in case of changes or prescriptions of new therapeutic regimes. The aim of this project is to evaluate the effectiveness of a multidomain intervention with an integrated care approach, in improving medication adherence in older people after hospital discharge. A secondary aim is investigate the determinants of poor comprehension and medication adherence in such individuals. Target population: The project will involve older patients hospitalized in a Geriatric Department and discharged at home, and (when present) their caregivers. Methods and assessments: Upon hospital discharge, data from the comprehensive geriatric assessment and information on the present hospitalization and prescribed therapies will be collected for all participants. The comprehension of medical recommendations reported in the discharge summary will be evaluated for all patients/caregiver before and after the routine explanation by treating physicians. Participants will be then randomized in intervention vs. control group. The intervention will include: first, educational training of patients/caregivers at hospital discharge by a multidisciplinary team; second, after hospital discharge, a phone recall on the prescribed therapies and a one-week phone consultant service managed by a geriatrician, supported by the multidisciplinary team, to address potential concerns on prescribed treatments. Control group will follow usual care. After 7 days medication adherence will be assessed for both study groups through structured phone interviews. At 30 and 90 days from discharge, data on falls, rehospitalizations and vital status will be collected through hospital records.
Detailed description
Background and overall goal: Poor comprehension and medication adherence are common in older people, especially after hospitalizations, in case of changes or prescriptions of new therapeutic regimes. The aim of this project is to evaluate the effectiveness of a multidomain intervention with an integrated care approach, in improving medication adherence in older people after hospital discharge. Moreover, a secondary aim is to investigate the determinants of poor comprehension and medication adherence in such individuals. Target population: The project will involve older patients hospitalized in a Geriatric Department and discharged at home, and (when present) their caregivers. Methods and assessments: Upon hospital discharge, data from the comprehensive geriatric assessment and information on the present hospitalization and prescribed therapies will be collected for all participants. The comprehension of medical recommendations reported in the discharge summary will be evaluated for all patients/caregiver before and after the routine explanation by treating physicians. Participants will be then randomized in intervention vs. control group. The intervention will include: first, educational training of patients/caregivers at hospital discharge by a multidisciplinary team; second, after hospital discharge, a phone recall on the prescribed therapies and a one-week phone consultant service managed by a geriatrician, supported by the multidisciplinary team, to address potential concerns on prescribed treatments. Control group will follow usual care. After 7, 30 and 90 days, data on medication adherence, falls, rehospitalizations and vital status will be assessed for both study groups through structured phone interviews and hospital records.
Interventions
BEHAVIORALEducational training
The intervention will include: first, educational training of patients/caregivers at hospital discharge by a multidisciplinary team; second, after hospital discharge, a phone recall on the prescribed therapies and a one-week phone consultant service managed by a geriatrician, supported by the multidisciplinary team, to address potential concerns on prescribed treatments.
Sponsors
University of Padova
University Hospital of Ferrara
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Participants will be randomized to the intervention vs. control group. The intervention will include: first, educational training of patients/caregivers at hospital discharge by a multidisciplinary team; second, after hospital discharge, a phone recall on the prescribed therapies and a one-week phone consultant service managed by a geriatrician, supported by the multidisciplinary team, to address potential concerns on prescribed treatments. Control group will follow usual care. After 7 days medication adherence will be assessed for both study groups through structured phone interviews. Over 30 and 90 days from discharge, data on falls, rehospitalizations and vital status will be collected through hospital records.
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
For the enrolment of the study participants, we will regularly monitor ward admissions, and potential eligibility of the patients will be evaluated by using the following inclusion criteria: * Patients hospitalized in the Geriatric Units of the Padua and Ferrara University Hospitals * Age 60 years or older * Patients living in the community setting and who will be discharged at home * Expected survival \>7 days
Exclusion criteria
* Patients discharged in long-term care facilities or other acute or post-acute wards * No consent to participate in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Comprehension of medical recommendation at hospital discharge | At baseline (corresponding to hospital discharge) | number of mistakes in recalling the prescribed therapy |
| Adherence to medical recommendations given at hospital discharge | 7 days after hospital discharge | number of discrepancies in taking the prescribed therapy |
| Adherence to the recommendations provided by the occupational therapist at hospital discharge | 7 days after hospital discharge | number of days per week of recommendations' adherence |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mortality | 7, 30 and 90 days after hospital discharge | Assessment of vital status through hospital records and telephone interviews |
| Number of rehospitalizations | 30 and 90 days after hospital discharge | Evaluation through structured telephone interviews |
| Number of falls | 30 and 90 days after hospital discharge | Evaluation through structured telephone interviews |
| Number of emergency department visits | 30 and 90 days after hospital discharge | Evaluation through structured telephone interviews |
Countries
Italy
Contacts
Primary ContactGiuseppe Sergi, MD, PhD
Backup ContactCaterina Trevisan, MD, PhD
Outcome results
None listed