Clinical Pharmacist Intervention to Reduce Drug-related Readmissions Among Older People
- Conditions
- Drug Use
- Interventions
- Other: Enhanced clinical pharmacist service
- Registration Number
- NCT03671629
- Lead Sponsor
- Umeå University
- Brief Summary
This randomized controlled trial primarily investigates if a clinical pharmacist intervention can reduce drug-related readmissions among patients \>75 years. The intervention targets the transfer between hospital and primary care. In brief, the intervention includes medical chart reviews and patient interviews during a period of 180 days.
- Detailed Description
At discharge from the hospital, patients that meet the inclusion criteria are offered to participate in the study. At this point the investigators will also gather baseline data through questionnaires on self-reported adherence (MARS-5) and quality of life (EQ-5D). The participants are randomized to the different study arms according to a stratified procedure based on their cognitive function.
The intervention group will have their charts reviewed every second week and be contacted by the clinical pharmacist through phone within 7 and after 30 and 60 days respectively to discuss their medications. If possible drug-related problems are suspected during the interviews that cannot be solved immediately, the physician is contacted.
Both groups have a follow-up time of 30 and 180 days. After 30 and 180 days, the patients will once again report adherence and quality of life. All other data can be gathered from the medical charts.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 700
- Living at home
- Acutely admitted
- Registered at one of ten pre-specified primary care health centers
- Patients unable to communicate or who do not speak Swedish
- Patients scheduled for palliative care
- Patients admitted due to intoxication by alcohol or drug (non prescription)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention group Enhanced clinical pharmacist service In addition to a standard medication review at the hospital, this group also receives an enhanced clinical pharmacist service during 180 days after discharge from the hospital.
- Primary Outcome Measures
Name Time Method Time from discharge to first drug-related readmission 180 days Survival analysis with drug-related readmission as endpoint
- Secondary Outcome Measures
Name Time Method Time from discharge to first drug-related readmission 30 days Survival analysis with drug-related readmission as endpoint
Frequency of drug-related readmissions - subgroups with/without heart failure 30 and 180 days Subgroup analysis among patients with/without heart failure
Time from discharge to first all-cause hospital visit 30 and 180 days Survival analysis with readmission or visit to the emergency department as endpoint
Frequency of drug-related readmissions 30 and 180 days Difference in total number of drug-related readmissions
Time from discharge to first drug-related readmission - subgroups with/without cognitive impairment 30 and 180 days Survival analysis among patients with/without cognitive impairment
Frequency of drug-related readmissions - subgroups with/without cognitive impairment 30 and 180 days Subgroup analysis among patients with/without cognitive impairment
Self-reported adherence 30 and 180 days Adherence to medications reported through MARS-5 ( Medication Adherence Rating Scale) and Swedish Prescribed Drug Register
Mortality 30 and 180 days Survival analysis with death as endpoint
Time from discharge to first drug-related readmission - subgroups with/without heart failure 30 and 180 days Survival analysis among patients with/without heart failure
Frequency of all-cause hospital visits 30 and 180 days Difference in total number of readmissions and visits to the emergency department
Self assessed quality of life: EQ-5D-questionnaire 30 and 180 days Health-related quality of life reported through the EQ-5D-questionnaire
Health economics 180 days Cost for visits for (drug-related) readmissions and to visits to the Emergency Department compared between patients in the control group and intervention group.
Medication appropriateness 180 days Medication appropriateness using the implicit Medication Appropriateness Index (MAI) and explicit tools in the form of the quality indicators published by the Swedish National Board of Health and Welfare and The European Union (EU)(7)-PIM list
Trial Locations
- Locations (1)
Medical Centre, University Hospital of Umeå
🇸🇪Umeå, Sweden