Comprehensive pharmaceutical care to prevent drug-related readmissions of dependent-living elderly patients: a randomized controlled trial

Abstract

BackgroundElderly patients are vulnerable to adverse drug reactions (ADRs). Drug-related readmissions (DRRs) can be a major consequence of ADR. Therefore, this study aimed to investigate the effects of a ward-based, comprehensive pharmaceutical care service on the occurrence of DRRs as the endpoint in dependent-living elderly patients.MethodsA randomized, controlled trial was performed at a German University Hospital. Patients fulfilling the following criteria were eligible: admission to a cooperating ward, existing drug therapy at admission, 65 years of age and older, home-care or nursing home residents in ambulatory care, and a minimum hospital stay of three days. Patients received either standard care (control group) or pharmaceutical care (intervention group). Follow-up consultations were conducted for each patient at 1, 8, 26, and 52 weeks after discharge. The time to DRR was defined as the primary outcome measure and was analysed using the log-rank test. The Cox-proportional hazard model was used for risk factor analysis.ResultsSixty patients (n = 31 intervention group, n = 29 control group) participated in the study. For patients in the intervention group, the median time to DRR was prolonged; however, the level of statistical significance was not reached (log-rank test P = 0.068; HR = 3.28, P = 0.086). When the risk factors ‘age’ or ‘length of stay on the ward’ were added to the Cox proportional hazard model, patients in the control group exhibited a significantly higher risk of experiencing a DRR than patients of the intervention group (HR = 4.62; P = 0.028 including age and HR = 5.76; P = 0.033 including length of stay on the ward).ConclusionsOur findings demonstrate the successful implementation of ward-based, comprehensive pharmaceutical care for dependent-living elderly. Despite a low participation rate, which led to an underpowered study, the results provide a preliminary efficacy signal and effect size estimates to power a definitive trial.Trial registrationClinicaltrials.gov identifier: NCT01578525, prospectively registered April 13, 2012.

Interventions to deprescribe potentially inappropriate medications in the elderly: Lost in translation ?

“…Only one study showed a statistically significant improvement in medication‐related hospital admissions in the primary analysis, whereas 3 showed improvement after post hoc analysis …”

“…The most commonly occurring CFIR domain was the inner setting. Within this domain, the most commonly occurring construct was Networks and Communication (seven papers) . Networks and Communication included topics such as the relationship between the pharmacist and the rest of the care team, which was the single most commonly identified implementation determinant identified in the papers that were reviewed.…”

“…Table summarizes findings related to intermediate outcome measures. Twelve of the 14 papers utilized such measures as part of their analysis, ranging from 1‐4 measures . The most commonly reported intermediate outcomes were number or rate of drug‐related problems (six papers), types of recommendations made (six papers) and rate of prescriber acceptance of the recommendations (six papers) …”

“…For example, the knowledge or training level of the professionals taking part in the intervention was given little attention. Only two authors referenced the clinical competencies and post‐graduate degrees of the pharmacists involved with their study . This falls under the ‘characteristics of individuals’ domain.…”

Investigating the effect of clinical pharmacist intervention in transitions of care on drug-related hospital readmissions among the elderly: study protocol for a randomised controlled trial

“…20 21 Regarding the effect on hospital readmissions and other clinical outcomes, review data are less consistent and incorporate few randomised controlled trials (RCTs) [22][23][24] ; however, there are relatively recent findings indicating that medication reviews conducted by clinical pharmacists on the ward can reduce drug-related readmissions to hospital in various groups of elderly people. [25][26][27] Postdischarge interventions involving phone-based follow-ups by clinical pharmacists have reduced all-cause readmission rates, but these trials did not specifically target an elderly population. 28 29 In addition, there seems to be a need for more RCTs that target medication discrepancies and errors during care transitions between hospital and primary care.…”