Educational Intervention to Reduce Drug-related Hospitalizations and Visits in Emergency Departments in Elderly Primary Health Care Patients - a Cluster-randomized Controlled Trial
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Polypharmacy
- Sponsor
- Karolinska Institutet
- Enrollment
- 69
- Locations
- 1
- Primary Endpoint
- Composite outcome: Unplanned hospitalisation or emergency department visit
- Status
- Completed
- Last Updated
- 12 years ago
Overview
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.
Investigators
Lars Agreus
Professor
Karolinska Institutet
Eligibility Criteria
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
Outcomes
Primary Outcomes
Composite outcome: Unplanned hospitalisation or emergency department visit
Time Frame: 9 months
Secondary Outcomes
- 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)