This randomized controlled trial primarily investigates if a clinical pharmacist intervention can reduce drug-related readmissions among patients \>75 years. The intervention targets the transfer between hospital and primary care. In brief, the intervention includes medical chart reviews and patient interviews during a period of 180 days.
At discharge from the hospital, patients that meet the inclusion criteria are offered to participate in the study. At this point the investigators will also gather baseline data through questionnaires on self-reported adherence (MARS-5) and quality of life (EQ-5D). The participants are randomized to the different study arms according to a stratified procedure based on their cognitive function. The intervention group will have their charts reviewed every second week and be contacted by the clinical pharmacist through phone within 7 and after 30 and 60 days respectively to discuss their medications. If possible drug-related problems are suspected during the interviews that cannot be solved immediately, the physician is contacted. Both groups have a follow-up time of 30 and 180 days. After 30 and 180 days, the patients will once again report adherence and quality of life. All other data can be gathered from the medical charts.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
700
The intervention includes regular medical chart reviews, multiple patient interviews and, if needed, collaboration with the primary care physician.
Medical Centre, University Hospital of Umeå
Umeå, Sweden
RECRUITINGTime from discharge to first drug-related readmission
Survival analysis with drug-related readmission as endpoint
Time frame: 180 days
Time from discharge to first drug-related readmission
Survival analysis with drug-related readmission as endpoint
Time frame: 30 days
Frequency of drug-related readmissions
Difference in total number of drug-related readmissions
Time frame: 30 and 180 days
Time from discharge to first drug-related readmission - subgroups with/without heart failure
Survival analysis among patients with/without heart failure
Time frame: 30 and 180 days
Time from discharge to first drug-related readmission - subgroups with/without cognitive impairment
Survival analysis among patients with/without cognitive impairment
Time frame: 30 and 180 days
Frequency of drug-related readmissions - subgroups with/without cognitive impairment
Subgroup analysis among patients with/without cognitive impairment
Time frame: 30 and 180 days
Frequency of drug-related readmissions - subgroups with/without heart failure
Subgroup analysis among patients with/without heart failure
Time frame: 30 and 180 days
Time from discharge to first all-cause hospital visit
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Survival analysis with readmission or visit to the emergency department as endpoint
Time frame: 30 and 180 days
Frequency of all-cause hospital visits
Difference in total number of readmissions and visits to the emergency department
Time frame: 30 and 180 days
Self-reported adherence
Adherence to medications reported through MARS-5 ( Medication Adherence Rating Scale) and Swedish Prescribed Drug Register
Time frame: 30 and 180 days
Self assessed quality of life: EQ-5D-questionnaire
Health-related quality of life reported through the EQ-5D-questionnaire
Time frame: 30 and 180 days
Health economics
Cost for visits for (drug-related) readmissions and to visits to the Emergency Department compared between patients in the control group and intervention group.
Time frame: 180 days
Medication appropriateness
Medication appropriateness using the implicit Medication Appropriateness Index (MAI) and explicit tools in the form of the quality indicators published by the Swedish National Board of Health and Welfare and The European Union (EU)(7)-PIM list
Time frame: 180 days
Mortality
Survival analysis with death as endpoint
Time frame: 30 and 180 days