Educational Intervention to Reduce Drug-related Hospitalizations in Elderly Primary Health Care Patients

Not Applicable

Completed

• Conditions: Polypharmacy; Adverse Drug Reaction
• Interventions: Other: Educational intervention

• Registration Number: NCT01732302
• Lead Sponsor: Karolinska Institutet

Brief Summary

The purpose of this study is to determine whether an educational intervention given towards health care providers working in primary health care centers can reduce inappropriate prescribing in the elderly patient and thus reduce number and length of drug-related hospitalizations as well as number of emergency department visits in this patient group.

Detailed Description

Inappropriate medication in the elderly patient leads to substantial morbidity, possibly causing up to 20% of hospitalizations in this patient group (1). To improve prescribing and thus reduce undesired drug effects is a great challenge for doctors and nurses in primary health care.

Performance of drug utilization reviews is recommended in order to reduce the negative impact of inappropriate prescribing in the elderly. However, scientific evidence on their efficacy is lacking, especially regarding patient-related health outcomes (2,3). Most studies are carried out in inpatient care, making it difficult to draw conclusions regarding primary health care (2). Moreover, studies in this scientific field diverge regarding the content and structure of drug utilization reviews, which implies that comparison between studies becomes challenging, if not impossible.

This trial aims at educating health care providers in how to perform drug utilization reviews, and to help them implement theory into practice.

Study Timeline

• Study Start: 2012-11
• Study First Submitted: 2012-11-19
• Study First Submitted QC: 2012-11-19
• Study First Posted: 2012-11-22
• Primary Completion: 2013-09
• Study Completion: 2013-09
• Status Verified: 2013-10
• Last Update Submitted: 2013-10-18
• Last Update Posted: 2013-10-21

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 69

Inclusion Criteria

• primary health care center in Stockholm County
• authorized by Stockholm County Council since at least 3 years
• at least 5% of patients attributed to primary health care center are 65 years and older
• primary health care center takes care of at least 10 home care patients

Exclusion Criteria

• less than 3000 patients listed in primary health care center
• primary health care centers where researchers carrying out the present study work

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Educational intervention	Educational intervention	Primary health care centers (PHCC) in the intervention group will be visited twice by a pharmacist within a period of three months. At the first visit, an educational intervention will focus on two properties: on the one hand, feed-back of actual patient data of the PHCC illustrating the primary-health-care-specific characteristics of inappropriate prescribing in the elderly patient will be given. Education of relevant subjects will be given in relation to detected problems. On the other hand, a clinical routine regarding the performance of drug utilization reviews will be developed in cooperation with the health care providers. At the second visit 3 months later, the developed concept will be critically reviewed and eventually developed further.

Primary Outcome Measures

Name	Time	Method
Composite outcome: Unplanned hospitalisation or emergency department visit	9 months

Secondary Outcome Measures

Name	Time	Method
Emergency department visit	9 months
Number of drug utilization reviews	9 months
Number of patients with polypharmacy	9 months	polypharmacy: 5-9 drugs/patient excessive polypharmacy: 10 and more drugs/patient
Inappropriate drug use according to national guidelines	9 months	see link
Unplanned hospitalisation	9 months
Length of hospital stay	9 months
All cause mortality	9 months
Number of patients with contraindicated drugs regarding renal function	9 months
Number of drugs with inappropriate drug dose regarding renal function	9 months
Number of drug interactions	9 months

Trial Locations

Locations (1)

Centre for Family Medicine, Dept of Neurobiology, Care sciences and Society, Karolinska Institutet; 🇸🇪 Huddinge, Sweden