A Multidisciplinary Approach to Improve Adherence to Medical Recommendations in Older Adults at Hospital Discharge
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 360
- 试验地点
- 4
- 主要终点
- Comprehension of medical recommendation at hospital discharge
研究概览
简要总结
Background and overall goal: Poor comprehension and medication adherence are common in older people, especially after hospitalizations, in case of changes or prescriptions of new therapeutic regimes. The aim of this project is to evaluate the effectiveness of a multidomain intervention with an integrated care approach, in improving medication adherence in older people after hospital discharge. A secondary aim is investigate the determinants of poor comprehension and medication adherence in such individuals.
Target population: The project will involve older patients hospitalized in a Geriatric Department and discharged at home, and (when present) their caregivers.
Methods and assessments: Upon hospital discharge, data from the comprehensive geriatric assessment and information on the present hospitalization and prescribed therapies will be collected for all participants. The comprehension of medical recommendations reported in the discharge summary will be evaluated for all patients/caregiver before and after the routine explanation by treating physicians. Participants will be then randomized in intervention vs. control group. The intervention will include: first, educational training of patients/caregivers at hospital discharge by a multidisciplinary team; second, after hospital discharge, a phone recall on the prescribed therapies and a one-week phone consultant service managed by a geriatrician, supported by the multidisciplinary team, to address potential concerns on prescribed treatments. Control group will follow usual care. After 7 days medication adherence will be assessed for both study groups through structured phone interviews. At 30 and 90 days from discharge, data on falls, rehospitalizations and vital status will be collected through hospital records.
详细描述
Background and overall goal: Poor comprehension and medication adherence are common in older people, especially after hospitalizations, in case of changes or prescriptions of new therapeutic regimes. The aim of this project is to evaluate the effectiveness of a multidomain intervention with an integrated care approach, in improving medication adherence in older people after hospital discharge. Moreover, a secondary aim is to investigate the determinants of poor comprehension and medication adherence in such individuals.
Target population: The project will involve older patients hospitalized in a Geriatric Department and discharged at home, and (when present) their caregivers.
Methods and assessments: Upon hospital discharge, data from the comprehensive geriatric assessment and information on the present hospitalization and prescribed therapies will be collected for all participants. The comprehension of medical recommendations reported in the discharge summary will be evaluated for all patients/caregiver before and after the routine explanation by treating physicians. Participants will be then randomized in intervention vs. control group. The intervention will include: first, educational training of patients/caregivers at hospital discharge by a multidisciplinary team; second, after hospital discharge, a phone recall on the prescribed therapies and a one-week phone consultant service managed by a geriatrician, supported by the multidisciplinary team, to address potential concerns on prescribed treatments. Control group will follow usual care. After 7, 30 and 90 days, data on medication adherence, falls, rehospitalizations and vital status will be assessed for both study groups through structured phone interviews and hospital records.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 60 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •For the enrolment of the study participants, we will regularly monitor ward admissions, and potential eligibility of the patients will be evaluated by using the following inclusion criteria:
- •Patients hospitalized in the Geriatric Units of the Padua and Ferrara University Hospitals
- •Age 60 years or older
- •Patients living in the community setting and who will be discharged at home
- •Expected survival >7 days
排除标准
- •Patients discharged in long-term care facilities or other acute or post-acute wards
- •No consent to participate in the study.
结局指标
主要结局
Comprehension of medical recommendation at hospital discharge
时间窗: At baseline (corresponding to hospital discharge)
number of mistakes in recalling the prescribed therapy
Adherence to the recommendations provided by the occupational therapist at hospital discharge
时间窗: 7 days after hospital discharge
number of days per week of recommendations' adherence
Adherence to medical recommendations given at hospital discharge
时间窗: 7 days after hospital discharge
number of discrepancies in taking the prescribed therapy
次要结局
- Number of rehospitalizations(30 and 90 days after hospital discharge)
- Number of emergency department visits(30 and 90 days after hospital discharge)
- Mortality(7, 30 and 90 days after hospital discharge)
- Number of falls(30 and 90 days after hospital discharge)