Prioritising Patient Medication Review: Hospitals Reaching Out (PriPMed)
概览
- 阶段
- 不适用
- 干预措施
- Clinical pharmacist
- 疾病 / 适应症
- Medication Review
- 发起方
- University of Southern Denmark
- 入组人数
- 800
- 试验地点
- 2
- 主要终点
- Readmission and emergency department rate.
- 状态
- 招募中
- 最后更新
- 19天前
概览
简要总结
To examine the effect of a cross-sectoral medication review intervention to admitted multi-morbid, polypharmacy patients aged 65+ at SHS in two settings; an acute admission unit (typical admission time < 48 hours) and a medical outpatient setting (patients routinely visits for follow-up, diagnosis or treatment, but do require a bed or overnight care).
详细描述
Lack of medication treatment coordination among especially multi-morbid patient's results in suboptimal medication treatment, adverse effects, increased use of resources, hospital admissions and premature death. Further, an aging population is a challenge to healthcare systems worldwide as older adults are vulnerable to non-communicable diseases and multi-morbidity. The age distribution varies across Denmark creating demographic inequality with a higher proportion of elderly in several municipalities in Southern Jutland and on a national level, the population aged 70+ already accounts for more than a third of all hospital days. As the population ages, the concept of frailty becomes increasing in the provision of health care to an ageing population, and the Clinical Frailty Scale (CFS) can be used as a judgement-based frailty tool to evaluate specific domains including comorbidity, function, and cognition to generate a frailty score. In addition, an attempt to detect patients at high risk of medication errors is the Medicine Risk Score (MERIS) where acutely admitted patients are allocated into low and high risk of potential ADEs by predefined detection limits. Further, These components will be used to determine In addition, an understudied patient group within polypharmacy and PIPs, are patients with dementia creating inequality among patient groups. The use of polypharmacy and Potential Inappropriate Prescribing are widespread in this patient group, and dementia is well-known to have a negative effect on overall mortality, which demonstrates the need for interventions to improve medication treatment in people with dementia. Intervention studies have examined the effects of pharmacist-led medication reviews in different hospital settings with various outcomes, but no exact model for prioritising patient medication review exists. Thus, there is a need to identify patients who will benefit most from a medication review in terms of outcomes, such as readmission, emergency department and general practitioner contacts. The aim of this project is to examine the effect of a cross-sectoral medication review between a clinical pharmacist and a medical specialist in coordination with the General Practitioner (GP), including patients from Hospital Sønderjylland, University Hospital of Southern Denmark (SHS).
研究者
入排标准
入选标准
- •all hospitalized patients who are prescribed at least seven medications specified in the Electronic Patient Journal (EPJ) at admission
排除标准
- •terminal patients or patients with a short life expectancy, patients residing in another region, patients who are discharged on the day of inclusion, and finally patients who do not speak Danish.
研究组 & 干预措施
Intervention group
The clinical pharmacist will assess the patient's medication, and perform interviews with the patient and/or the patient's attorney-in-fact. Potential medical recommendations will be discussed with the treating hospital clinician and the clinical pharmacist, and a medication plan will be developed together with the patient or the patient's attorney-in-fact. The GPs will be informed through optimized discharge summaries.
干预措施: Clinical pharmacist
Control group
Patients in the control group receive standard care without a clinical pharmacist involved in the healthcare team at ward level. Standard care consists of usual treatment from a team of hospital physicians, nurses, nurse assistants, and as needed occupational therapists, physiotherapist, and clinical dieticians. Hospital physicians and/or nurses might perform patient counselling about medication treatment during hospitalization
结局指标
主要结局
Readmission and emergency department rate.
时间窗: Up to thirty days after discharge
The number of acute readmissions and emergency department visits between 4 hours and 30 days after discharge from the index hospital stay in the intervention group compared with the control group. As a "yes" or "no" and a time-to-event. Potential readmissions are assessed through the electronic patient journal.
次要结局
- Acute admission(Up to 90 days after discharge)
- Implementation rate(Up to 90 days after discharge)
- Compliance with medical treatment(Up to 90 days after discharge)
- Mortality(30 and 90 days after discharge)
- GP contacts(Up to 90 days after discharge)