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

Abstract

IntroductionDrug-related problems (DRPs) are a major cause of unplanned hospital admissions among elderly people, and transitions of care have been emphasised as a key area for improving patient safety. We have designed a complex clinical pharmacist intervention that targets people ≥75 years of age undergoing transitions of care from hospital to home and primary care. The main objective is to investigate if the intervention can reduce the risk of unplanned drug-related readmission within the first 180 days after the person is discharged from hospital.Methods and analysisThis is a randomised, controlled, superiority trial with two parallel arms. A total of 700 people ≥75 years will be assigned to either intervention or routine care (control). The intervention, which aims to find and manage DRPs, is initiated within a week of the person being discharged from hospital and combines repeated medical chart reviews, phone interviews and in some cases medication reviews. People in both study arms may have been the subject of a medication review during their ward stay. As the primary outcome, we will measure time until unplanned drug-related readmission within 180 days of leaving hospital and use log rank tests and Cox proportional hazard models to analyse differences between the groups. Further investigations of subgroup effects and adjustments of the regression models will be based on heart failure and cognitive impairment as prognostic factors.Ethics and disseminationThe study has been approved by the Regional Ethical Review Board in Umeå (registration numbers 2017-69-31M, 2018-83-32M and 2018-254-32M). We intend to publish the results with open access in international peer-reviewed journals and present our findings at international conferences. The trial is expected to result in more than one published article and form part of two PhD theses.Trial registration numberNCT03671629

Effects of Hospital-Based Comprehensive Medication Reviews Including Postdischarge Follow-up on Older Patients’ Use of Health Care

“…Some RCTs with similar interventions aimed at improving health outcomes in older patients are currently underway. 43 , 44 , 45 , 46 While we await the results of these trials, this study creates the opportunity to reflect on how to improve medication use in hospital practice and after discharge and to subject improved interventions to RCTs, with the aim of optimizing treatment outcomes and minimizing medication-related harm.…”

“…Some RCTs with similar interventions aimed at improving health outcomes in older patients are currently underway. [43][44][45][46] While we await the results of these trials, this study creates the opportunity to reflect on how to improve medication use in hospital practice and after discharge and to subject improved interventions to RCTs, with the aim of optimizing treatment outcomes and minimizing medication-related harm. Funding/Support: The Medication Reviews Bridging Healthcare (MedBridge) trial has received governmental research grants RFR-555601, RFR-641791, and RFR-735911 from the Uppsala-Örebro Regional Research Council, grants LUL-527721, LUL-614061, LUL-716201, and LUL-821261 from Region Uppsala, grants CFUG-658451 and CFUG-698771 from Region Gävleborg, and grants LTV-675921, LTV-712341, LTV-736641, and LTV-840112 from Region Västmanland; funding from the Swedish Pharmacists Association (Sveriges Farmaceuter), the Thuréus Fund for Geriatric Research (Thuréus stiftelse för främjande av geriatrisk forskning), and the Geriatric Fund (Geriatriska fonden); and grants FA 2017:38 and FA 2018:43 from the Swedish Heart and Lung Association (Riksförbundet HjärtLung).…”

Self-Reported Medication Adherence Among Older People Admitted to Hospital: A Descriptive Study

“…This descriptive study is based on data from an ongoing randomized controlled study (main study) [ 17 ]. The Medication Adherence Report Scale (MARS-5) questionnaire is applied during the admission period (baseline), then 30 days and 180 days after discharge from hospital.…”

“…The main study is a randomized controlled trial with two parallel arms (intervention vs conventional care) [ 17 ]. The primary objective is to assess whether intervention by a clinical pharmacist during a transition of care can reduce the risk of unplanned drug-related hospital readmission for 180 days after the person leaves the hospital.…”

Older Individuals’ Experiences of Medication Management and Care After Discharge from Hospital: An Interview Study

“…This study was based on an ongoing intervention study where participants were admitted to internal medicine or orthopedic department. 20 In this interview study, participants from both wards were included to be able to conduct at purposeful sampling. The departments receive acute internal medicine and orthopedic patients 24 hours a day, all year round and have 12–24 and 18–34 nursing places, respectively.…”