Polypharmacy Usage of multiple medicines
Conditions
Interventions
 
TMPC consists of four elements: 
1. pharmacotherapeutic analysis 
2. transitional multidisciplinary discussion 
3. pharmacotherapeutic care interview and discussion with the patient 
4. discharge note with the pharmacotherapeutic care plan
Comparator: 
The comparator is usual care as is provided in the participating hospitals. 
Sponsors
Radboud Universitair Medisch Centrum
Eligibility
Age
65 Years to 99 Years
Inclusion criteria
Inclusion criteria: • 70 years or older • Polypharmacy, the use of 5 or more regular medications, defined as authorised medications with registration numbers, used for more than 30 days. Topical preparations are excluded from this definition. • Admitted to hospital through the ED (which comprises both the general emergency department and the cardiac emergency department) • Length of hospitalisation more than 24 hours • Completed medication verification • DRA prediction percentage of 23.0% or higher (see research protocol chapter 4.2.1. for more extensive information)
Exclusion criteria
Exclusion criteria: • No informed consent by patient or a legal representative • Participation in an interfering clinical trial • Elective hospital admission • Direct admission to the ICU (when medication verification as usual can*t be executed, and therefore inclusion of patients as described in 10.2 is not possible) • A life expectancy of less than 3 months, which includes patients with palliative treatment at home, direct admission to palliative care or palliative care planned within 24 hours after index hospital admission. • Patient or legal representative not able to speak Dutch. • Follow-up of patient primarily by secondary caregivers. This refers to situations where the secondary caregiver is in the lead of the medication list of the patient instead of the GP or elderly care physician, for example in the following patient groups: o patients receiving intensive oncologic therapy o patients in an organ- or stem cell transplantation procedure o patients receiving intensive (chronic) psychiatric care, such as patients admitted to a medical psychiatric unit o patients on dialysis
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The primary outcome is the occurrence of DRreAs in the first 30 days after discharge. Drug relatedness of the admission will be determined using the AT-HARM10 tool, executed by trained pharmacy students. | — |
Secondary
| Measure | Time frame |
|---|---|
| Main secondary outcome is cost-effectiveness in euro per QALY (quality adjusted life year) gained. Other outcomes include: - Number of DRreAs at 3 months and 12 months - Duration of hospitalisation of DRreA at 30 days, 3 months and 12 months - Time to first DRreA at 30 days, 3 months and 12 months - Number of drug related ED visits at 30 days, 3 months and 12 months - Number of all-cause readmission and ED visits at 30 days, 3 months and 12 months - Healthcare costs over the 12-month period - Quality of Life at 30 days, 3 months and 12 months - Number of regular medications at discharge, 30 days, 3 months and 12 months - Number and type of recommendations in the pharmacotherapeutic plan in the intervention group at discharge - Number of implemented recommendations from the pharmacotherapeutic plan in the intervention group at 30 days, 3 months and 12 months. - ADL at 30 days, 3 months and 12 months - Number of participants living independently at 30 days, 3 months and 12 months - Number of falls at 30 days, 3 months and 12 months - Mortality at 30 days, 3 months and 12 months | — |
Countries
Netherlands
Contacts
Public ContactE.M.C. Engelen
Amsterdam UMC
Outcome results
None listed