Suboptimal use of medications among geriatric patients is well-known problem and leads to medication errors, re-hospitalizations and death. By using a randomized controlled trial (RCT) design the investigators aim to explore a new inter-professional working structure. The working structure is based on the scientifically and clinically acknowledged integrated medicines management (IMM) model. The overall aim of the study is to explore the effect of the new working structure on the composite endpoint re-hospitalization + visit to an emergency department during 12 months after hospital discharge.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
516
A pharmacist is integrated in the team surrounding the patient, working by the Integrated Medicines Management (IMM) model. The IMM-model consist of medication reconciliation, medication review, standardized medication reports and counseling patients about their medication at discharge. In addition a phone meeting between the primary care physician and the study pharmacist is added after discharge.
University hospital of North Norway
Tromsø, Norway
Emergency medical visits
Rate of emergency Medical visits at 12 months. Emergency Medical visits is a composite endpoint including emergency department visits and unscheduled hospitalization
Time frame: 12 months after hospital discharge
Self-reported quality of life
Change in self-reported quality of life using the validated EQ-5D
Time frame: 1 months after hospital discharge
Self-reported quality of life
Change in self-reported quality of life using the validated EQ-5D
Time frame: 6 months after hospital discharge
Self-reported quality of life
Change in self-reported quality of life using the validated EQ-5D
Time frame: 12 months after hospital discharge
length in days of index hospital stay
Days from hospital admission to discharge of index hospital stay
Time frame: Days from hospitalization to discharge of index hospital stay, assessed up to 12 months
Time to first rehospitalization
Days to first hospitalization
Time frame: First rehospitalization after discharge from index hospital stay, up to 12 months after discharge.
Visits to primary care physician
Visitation rate at 12 months
Time frame: 12 months after discharge for index hospital stay
Mortality rate
Time frame: 12 months after randomization
Total score of the Medication appropriateness index (MAI)
Time frame: Baseline at randomization
Change in total score of the Medication appropriateness index (MAI)
Time frame: From baseline to date of discharge from hospital, assessed up to 12 months
Inappropriate medications identified through the Norwegian general practice criteria (NORGEP)
Time frame: Baseline at randomization
Change in Inappropriate medications identified through the Norwegian general practice criteria (NORGEP)
Time frame: From baseline to date of discharge from hospital, assessed up to 12 months
Change in inappropriate medications identified through the Norwegian general practice criteria (NORGEP)
Time frame: From baseline to 3 months after discharge from index hospital stay, assessed up to 12 months
Potentially inappropriate prescribing identified through the Screening Tool to Alert doctors to Right treatment (START)
Time frame: Baseline at randomization
Change in potentially inappropriate prescribing identified through the Screening Tool to Alert doctors to Right treatment (START)
Time frame: From baseline to date of discharge from hospital, assessed up to 12 months
Potentially inappropriate prescribing identified through the Screening Tool of Older Persons' Prescriptions (STOPP)
Time frame: Baseline at randomization
Change in potentially inappropriate prescribing identified through the Screening Tool of Older Persons' Prescriptions (STOPP)
Time frame: From baseline to date of discharge from hospital, assessed up to 12 months
Change in potentially inappropriate prescribing identified through the Screening Tool of Older Persons' Prescriptions (STOPP)
Time frame: From baseline to 12 months after discharge from hospital
Changes in medication, identified through screening of drug lists at their primary care physician.
Drug changes made during hospitalization implemented by the primary care physician.
Time frame: 12 months after discharge from index hospital stay
Changes in medication, identified through screening of drug lists at their primary care physician.
Drug changes made during hospitalization implemented by the primary care physician.
Time frame: 3 months after discharge from index hospital stay
Rehospitalizations where the reason for hospitalization is possibly, probably or certainly drug-related.
A chart review will be done retrospectively to evaluate if the patients first rehospitalization was drug related or not. Classified by a multiprofessional team of experts
Time frame: First rehospitalization after discharge from index hospital stay, up to 12 months after inclusion in study
Hip fracture
Rate of hip fractures
Time frame: 12 months after discharge from index hospital stay
Stroke
Stroke rate during 12 months follow-up
Time frame: 12 months after discharge from index hospital stay
The proportion of patients readmitted acutely within 30 days
Time frame: 30 days after discharge from index hospital stay
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