Medication Review in Chronic Complex or Polymedicated Patients After Hospital Discharge.
- Conditions
- Disease, ChronicMedication ReviewPolypharmacy
- Interventions
- Behavioral: Multidisciplinary medication reviewBehavioral: Control group
- Registration Number
- NCT05799430
- Brief Summary
The goal of this prospective multicentre clustered randomized controlled trial is to evaluate the effect on new hospitalization episodes of a multidisciplinary medication review in primary care patients with polypharmacy or chronic complex conditions after hospital discharge.
The multidisciplinary team will be integrated by a family physician (FP), a primary care nurse (PCN) and a primary care pharmacist (PCP). Patient will be adults aged 65 years and older. Polypharmacy refers to the use of 10 or more drugs based on information in electronic prescription software.
Research questions are:
In elderly patients with polypharmacy, which is the effect of an interdisciplinary medication review after hospital discharge in comparison with standard care, in terms of:
* new hospitalization episodes?
* number of drugs prescribed?
* prescribed drugs adequacy?
- Detailed Description
Centres will be randomized to medication review intervention or usual care group. Eligible patients will be ask for informed consent. For patients in the intervention group, PCP will collect information about prescribed medication and diseases from the electronic health record and e-prescribing application. The medication review in primary care will be focus to reconcile the medications the patient was taking prior to admission and those initiated in hospital, with the medications they should be taking post-discharge to ensure all changes are intentional and that discrepancies are resolved as soon as possible. The review process will include detection of potential drugs interactions, wrong doses, lack of adherence (based on dispensing recorded data) and adequacy to explicit criteria for potentially inappropriate prescriptions included in different tools: a) STOPP-STAR, STOPP-Pal, LESS-CHRON lists; b) Guideline for Medication Review in Primary Care, a local publication and c) Medication review in patients with polypharmacy. A list of drugs frequently associate with potentially inappropriate prescriptions. Andalusian health Service). PCP will write a report to communicate the results of medication review to primary care physician and nurse. The multidisciplinary team will define a personalized therapeutic plan to be implemented for every patient.
Patients in the control group will receive usual care.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 372
- Hospital discharge in the last 48 h and one of the following conditions:
- Polypharmacy: ten o more drugs prescribed in a chronic schedule OR
- Complez Chronic Condition
- Patients in last days of life
- Major mental health disorder
- Patient on dialysis
- Organ transplant patients
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention Multidisciplinary medication review The intervention group will receive a multidisciplinary medication review and a personalized therapeutic plan in the following 72 hours after hospital discharge. The intervention will be developed by a multidisciplinary team that includes a family physician (FP), a primary care nurse (PCN) and a primary care pharmacist (PCP). PCP is a pharmacist working in a full-time base for the Pharmacy Service in a Primary Care District in Andalusian Public Health Service. Control group Control group The control group will receive usual care.
- Primary Outcome Measures
Name Time Method Number of hospitalization episodes 12 months Registered in Electronic Health Record. In emergency department or in hospital service
Length of Hospital Stay 12 months Registered in Electronic Health Record.
- Secondary Outcome Measures
Name Time Method Healthcare utilisation 12 months Number of visits to primary care services (family physician or primary care nurse) and hospital services (non emergency and without hospitalization)
Mortality 12 month Dead for any cause
Number of medications 12 months Total number of drugs chronically prescribed (treatment length: unless 120 days)
Number of proposal about treatment improvement agreed with primary care team 7 days Number of proposal about treatment improvement agreed with primary care team in a face face meeting
Number of potentially inappropriate drugs 12 months Total number of potentially inappropriate prescribed drugs based on explicit criteria
Number of proposal about treatment improvement 7 days Number of proposal about treatment improvement included in PCP report
Number of proposal about treatment improvement accepted by the patient or care 7 days Number of proposal about treatment improvement agreed with primary care team in a face face meeting
Trial Locations
- Locations (1)
Sevilla Primary Care District
🇪🇸Sevilla, Spain