Polypharmacy
Conditions
Brief summary
Systematic evaluation of polypharmacy in geriatric patients, through a validated list by a clinical pharmacist. The goal is reduction of potentially inappropriate medications (PIMs). A brief counseling session with the patient and/or his/her caregiver will be part of the intervention.
Detailed description
This project is focused on the systematic evaluation of polypharmacy in older patients admitted to the acute geriatric wards of a university hospital. Polypharmacy will be identified through a validated list by a clinical pharmacist. The goal is reduction of potentially inappropriate medications (PIMs). Before hospital discharge the hospital pharmacist will have a brief counseling session with the patient and/or his/her caregiver in order to discuss the medication list and to enhance compliance.
Interventions
PROCEDUREMedication review and discharge counseling
Medication reconciliation of home therapy will be performed by the clinical pharmacist through a standardized form. Next, the clinical pharmacist will perform a medication review, based on but not limited to the RASP list (Van der Linden 2014). The goal is optimization of therapy. Before discharge the clinical pharmacist will perform a second medication review, together with the treating physician and a medication reconciliation in orde to provide the best possible discharge medication list. The medication list will be provided 3 times: once for the patient and/or his/her caregiver, once for the general practitioner and once for the primary care pharmacist. Finally the clinical pharmacist will have a counseling session with the patient and/or his/her caregiver.
Sponsors
Universitaire Ziekenhuizen KU Leuven
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
75 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Informed consent by the patient and/or his/her caregiver * Admission through the emergency department of patients coming from home or a residential care facility
Exclusion criteria
* Patients not speaking Dutch * Patients admitted for end of life care * Patients not taking any drugs on admission
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Acceptance rate of the pharmacotherapeutic recommendations, provided by the clinical pharmacist by the general practitioner. | 1 month (30 days) after discharge | Acceptance rate of the pharmacotherapeutic recommendations, provided by the clinical pharmacist by the general practitioner. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of drugs at discharge versus at admission. | At discharge from the index hospitalization (as mentioned in the discharge medication scheme) vs on admission (during the first 72 hours of the index hospitalization) | Number of drugs at discharge versus at admission. |
| Number of drugs adapted by the treating physician based on recommendations by the clinical pharmacist that are not included in the RASP list. | At discharge from the index hospitalization (as mentioned in the discharge medication scheme), compared to the medication list obtained on admission (this is, during the first 72 hours of the hospitalization) | Number of drugs adapted by the treating physician based on recommendations by the clinical pharmacist that are not included in the RASP list. |
| Difference in number of potentially inappropriate medications identified through the RASP list on admission versus at discharge | At discharge from the index hospitalisation (as mentioned in the discharge medication scheme) versus on admission (medication list obtained in the first 72 hours) of the index hospitalization | Difference in number of potentially inappropriate medications identified through the RASP list on admission versus at discharge |
| Number of potentially inappropriate medications on admission, at discharge and at the follow-up moments (1 and 3 months after discharge) | On admission (medication list obtained in the first 72 hours of the admission), at discharge (as mentioned in the discharge medication scheme), 1 (30 days) month after discharge, 3 months (90 days) after discharge | Number of potentially inappropriate medications on admission, at discharge and at the follow-up moments (1 and 3 months after discharge) |
| Mortality during admission | During the index hospitalization, from admission to the emergency ward until moment of death on the geriatric ward, assessed up to 72 hours after death. | Mortality during admission |
| Number of falls during hospitalization | During the index hospitalization, from admission on the emergency ward until discharge from the geriatric ward, assessed within 72 hours after discharge. | Number of falls during hospitalization |
| Number of fractures during hospitalization | during the index hospitalization, from admission to the emergency ward until discharge from the geriatric ward, assessed within 72 hours after discharge. | Number of fractures during hospitalization |
| Length of stay | During the index hospitalization, from admission to the emergency ward until discharge from the geriatric ward, assessed within 72 hours after discharge. | Length of stay |
| Number of drug intakes at discharge versus at admission. | At discharge from the index hospitalization (as mentioned in the discharge medication scheme) vs on admission (during the first 72 hours of the index hospitalization) | Number of drug intakes at discharge versus at admission. |
| Number of fractures at 3 months after discharge | 3 months (90 days) after discharge from the geriatric ward (index hospitalization), assessed at day 90 | Number of fractures at 3 months after discharge |
| Number of falls 3 months after discharge | 3 months (90 days) after discharge from the geriatric ward (index hospitalization), assessed at day 90 | Number of falls 3 months after discharge |
| Mortality at 3 months after discharge | 3 months (90 days) after discharge from the geriatric ward (index hospitalization), assessed at day 90 | Mortality at 3 months after discharge |
| Category of potentially inappropriate medications identified through the RASP list on admission and at discharge | On admission (medication list obtained in the first 72 hours of the admission), at discharge (as mentioned in the discharge medication scheme) | Category of potentially inappropriate medications identified through the RASP list on admission and at discharge |
| Category of drugs adapted by the treating physician based on recommendations by the clinical pharmacist that are not included in the RASP list. | During the course of the index hospitalization, defined as the period between discharge from the geriatric ward and admission to the geriatric department. The outcome parameter will be assessed within 72 hours of discharge. | Category of drugs adapted by the treating physician based on recommendations by the clinical pharmacist that are not included in the RASP list. |
| Number of drugs at follow-up (1 month and 3 months after discharge) | 1 month (30 days) and 3 months (90 days) after the index hospitalization | Number of drugs at follow-up (1 month and 3 months after discharge) |
| Number of drug intakes at follow-up (1 month and 3 months after discharge) | 1 month (30 days) and 3 months (90 days) after the index hospitalization | Number of drug intakes at follow-up (1 month and 3 months after discharge) |
| Readmission rate 3 months after discharge | 3 months (90 days) after discharge from the geriatric ward (index hospitalization), assessed at day 90 | Readmission rate 3 months after discharge |
Countries
Belgium
Outcome results
None listed