A randomized controlled trial will be performed in geriatric inpatients to investigate the impact of a multifaceted clinical pharmacy intervention on health related outcomes.
Since drug-related harm remains persistently prevalent in older adults, there is an urgent and unmet clinical need to optimize pharmacotherapy both during hospital stay and after discharge Therefore, we aim to perform a randomized controlled trial in geriatric inpatients to investigate the impact of a multifaceted clinical pharmacy intervention on health related outcomes. The primary objective is to reduce all-cause unplanned hospital visits in geriatric inpatients. Secondary objective are to optimize drug therapy in geriatric inpatients and improve their health; To empower and educate patients, caregivers,community pharmacists and physicians regarding drug regimen decisions to maximize therapy adherence and the understanding of the (de)prescribing process and to enhance healthy ageing; To optimize transitional care from the hospital to primary care.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
827
1. Assessing patient and caregiver preferences 2. Medication reconciliation on admission 3. Performing a comprehensive medication review before discharge 4. Promoting safe transition 4.a. Compiling a patient friendly medication list 4.b.Optimizing communication with healthcare providers in primary care: 4.b.i.Providing a copy of the medication list for the community pharmacist 4.b.ii. Contacting the general practitioner by phone 4.b.iii. Contacting, if applicable the home care nurse or the nurse from the nursing home by phone. 5.A motivation interview will take place before discharge with patients and caregivers 6.Post-discharge follow-up: 6.a.Follow-up call to discuss potential drug therapy issues, therapy adherence and to resolve any pending issues 6.b.A telepharmacology service will be provided to primary healthcare professionals as a means to consult the ward-based clinical pharmacists and/or research team after discharge.
University Hospitals Leuven
Leuven, Belgium
Time to all-cause unplanned hospital visit after discharge.
An unplanned hospital visit is defined as an unplanned hospital admission or an emergency department visit
Time frame: up to six months after discharge
General practitioners contacts
Number of general practitioners contacts
Time frame: Up to six months after discharge
Mortality
Death date
Time frame: Up to six months after discharge
Other types of hospital visits
Number of planned hospital admissions, number of emergency department visits, number of unplanned hospital admissions
Time frame: Up to six months after discharge
Drug-related readmissions
Number of drug related readmissions
Time frame: Up to six months after discharge
Fall incidents
Number of falls
Time frame: Up to one month after discharge
Patient reported drug related problems
Number of drug related problems
Time frame: Up to one month after discharge
Change in Quality of life
five-level version of the EuroQol five-dimensional (EQ5D) descriptive system (EQ-5D-5L) questionnaire. values will be tranformed using a value set to a score from 0 - 1 (a higher score indicating a better quality of life)
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Time frame: on admission, one month after discharge and six months after discharge
Differences in pain
Numeric Rating Scale (NRS score) once a week (min 0 - max 10), a higher score indicating more pain
Time frame: Up to one month after discharge
Medications
Number of medications
Time frame: On admission, at discharge and one month after discharge
Medication adherence
BAASIS tool
Time frame: On admission and one month after discharge
Potentially inappropriate medications
RASP tool
Time frame: On admission, at discharge and one month after discharge
Cost-effectiveness
Healthcare related costs and Medicine productivity costs
Time frame: Up to six months after discharge