Rationalisation of Polypharmacy by the RASP-instrument (Rationalisation of Home Medication by an Adjusted STOPP-list and Discharge Counselling of Geriatric Inpatients: a Prospective, Clinical Trial

Brief Summary

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.

Primary Outcomes

Secondary Outcomes

• 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 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.)
• 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.)
• 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 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 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 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 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)
• 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.)
• Number of falls 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(3 months (90 days) after discharge from the geriatric ward (index hospitalization), assessed at day 90)
• Mortality at 3 months after discharge(3 months (90 days) after discharge from the geriatric ward (index hospitalization), assessed at day 90)
• 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 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))
• 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)
• 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 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))