Educational Intervention to Reduce Drug-related Hospitalizations and Visits in Emergency Departments in Elderly Primary Health Care Patients - a Cluster-randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 69
- 试验地点
- 1
- 主要终点
- Composite outcome: Unplanned hospitalisation or emergency department visit
研究概览
简要总结
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.
详细描述
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.
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
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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
排除标准
- •less than 3000 patients listed in primary health care center
- •primary health care centers where researchers carrying out the present study work
研究组 & 干预措施
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.
干预措施: Educational intervention (Other)
Delayed educational intervention
Primary health care centers in the delayed intervention group will receive the same intervention as described above with 9 months delay.
结局指标
主要结局
Composite outcome: Unplanned hospitalisation or emergency department visit
时间窗: 9 months
次要结局
- Emergency department visit(9 months)
- Number of drug utilization reviews(9 months)
- Number of patients with polypharmacy(9 months)
- Inappropriate drug use according to national guidelines(9 months)
- 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)
研究者
Lars Agreus
Professor
Karolinska Institutet