Intervention to Improve Prescribing in Elderly Patients
- Conditions
- Elderly Internal Medicine Patients
- Interventions
- Other: Checklist
- Registration Number
- NCT02712268
- Lead Sponsor
- University Hospital, Basel, Switzerland
- Brief Summary
This study tested the efficacy of an easy-to-use checklist aimed at supporting the therapeutic reasoning of physicians in order to reduce inappropriate prescribing and polypharmacy in elderly adults admitted to an internal medicine unit.
- Detailed Description
Background: Polypharmacy and inappropriate medication prescriptions are associated with increased morbidity and mortality. Most interventions proposed to improve appropriate prescribing are time and resource intensive and therefore hardly applicable in daily clinical practice.
Objective: To test the efficacy of an easy-to-use checklist aimed at supporting the therapeutic reasoning of physicians in order to reduce inappropriate prescribing and polypharmacy.
Design: single-center, interventional, quasi-experimental before-after study. Patients: Consecutive patients aged ≥65 years, hospitalized in the division of internal medicine of a Swiss secondary-level hospital from September to November 2012 (control group, N=450) and from September to November 2013 (intervention group, N=450).
Intervention: Introduction of a 5-point checklist to be used by all physicians on the internal medicine wards.
Main Measures: The proportion of patients with prescription of potentially inappropriate medications (PIMs) at discharge, according to Screening tool of older people's prescriptions (STOPP) criteria, and the number of prescribed medications at discharge, before and after the introduction of the checklist. Secondary outcomes were the prevalence of polypharmacy (≥ 5 drugs) and hyperpolypharmacy (≥ 10 drugs), and the prevalence of potentially inappropriate prescribing omissions (PPOs) according to START criteria.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 450
- Consecutive patients aged ≥65 years,
- patients hospitalized in the division of internal medicine of a Swiss secondary-level hospital from September to November 2012 (control group, N=450) and from September to November 2013 (intervention group, N=450).
- none
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description After introduction of the checklist Checklist Review of medications of all consecutive admitted patients during the study period using a checklist
- Primary Outcome Measures
Name Time Method Change in the number of prescribed medications at discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) Number of prescribed medications at discharge, before and after the introduction of the checklist.
Change in the proportion of patients prescribed potentially inappropriate medications (PIM) at discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) The proportion of patients prescribed PIMs at discharge, according to STOPP (Screening Tool of Older Person's potentially inappropriate Prescriptions) criteria, before and after the introduction of the checklist.
- Secondary Outcome Measures
Name Time Method Rate (%) of inappropriate prescriptions of NSAID at admission and discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) Non-steroidal anti-inflammatory drugs (NSAID)
Number of patients prescribed NSAID at admission and discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) Non-steroidal anti-inflammatory drugs (NSAID)
Prevalence of polypharmacy at admission and discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) concomitant use of more than 5 drugs
Prevalence of potentially inappropriate prescribing omissions (PPO) at admission and discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) according to START (Screening Tool of Alert doctors to the Right Treatment) criteria
Number of prescribed drugs at admission and discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) Prevalence of hyperpolypharmacy at admission and discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) concomitant use of more than 10 drugs
Number of patients prescribed proton pump inhibitors at admission and discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) proton pump inhibitor (PPI)
Number of patients prescribed systemic corticosteroids at admission and discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) In-Hospital mortality rate In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) Rate (%) of inappropriate prescriptions of proton pump inhibitors at admission and discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) proton pump inhibitor (PPI)
Number of patients prescribed metamizole at admission and discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) Rate (%) of inappropriate prescriptions of systemic corticosteroids at admission and discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) All-cause re-hospitalization rate In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group) re-hospitalization rate 30 days after discharge
Rate (%) of inappropriate prescriptions of metamizole at admission and discharge In the 3 months after introduction of the checklist (Sept.-Nov. 2013, intervention group) and in 3 months (Sept.-Nov. 2012) one year before the introduction of the checklist (control group)