The aim of this study is to determine whether a clinical pharmacist using the RASP list (RASP = Rationalisation of home medication by an adjusted STOPP-list in older patients; STOPP = Screening Tool of Older Persons' potentially inappropriate Prescriptions) can optimise the drug use in elderly inpatients.
Older persons take on average multiple drugs. As people age, there is an apparent increase in pharmacodynamic sensitivity to different making the patient more prone to experience side effects. Alterations in body composition and concomitant changes in pharmacokinetic parameters can also result in a higher risk for adverse drug events. All these factors make the older person, notwithstanding the heterogeneity of this population, more vulnerable for the negative consequences of polypharmacy. Polypharmacy is a cause of negative clinical outcomes but it still remains unclear which intervention or set of interventions should be used to optimize the prescription of pharmacotherapy in the elderly patient. Therefore, the investigators developed the RASP (RASP = Rationalisation of home medication by an adjusted STOPP-list in older patients; STOPP = Screening Tool of Older Persons' potentially inappropriate Prescriptions), a list as tool to reduce polypharmacy adapted to Belgian national prescribing tendencies within geriatric wards. Content and reliability of the RASP have been validated and the investigators aim to further study the impact of the systematic implementation of this RASP on geriatric wards in a prospective cluster randomized controlled trial.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
172
Drug use of subjects enrolled in this arm will be systematically evaluated by a clinical pharmacist, using the RASP list. Potentially inappropriate drug use will be pointed out to the treating physician. The pharmaceutical advice is not limited to the RASP list. Any actual change in drug prescription will be decided by the treating physician based upon comprehensive medical evaluations in each individual patient.
Universitaire Ziekenhuizen Leuven
Leuven, Vlaams-Brabant, Belgium
Number of actually stopped or adjusted drugs
At hospital discharge the number of stopped or adjusted drugs will be determined. This variable will be compared between the two arms.
Time frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days.
Number of potentially inappropriate drug prescriptions as defined by the RASP.
Time frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days.
Actual drug use
Time frame: Measured on 30 and 90 days post-discharge.
Number and category of drugs adjusted on recommendations of the clinical pharmacist independent of RASP
Time frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days.
Mortality
Time frame: Measured during hospitalisation, an expected average of 14 days and within 90 days after discharge.
Number of falls
Time frame: Measured during hospitalisation, an expected average of 14 days and within 90 days after discharge
Quality of Life (EQ-5D-3L)
Time frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days.
Length of stay
Time frame: Determined at discharge, on average after 14 days
Rehospitalisation
Time frame: Within 90 days post-discharge.
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Incidence of delirium
Time frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days
Number of falls post-discharge
Time frame: Within 90 days post-discharge