Cross-Sectional Study Clinical Trial
Official title:
The Impact of Pharmaceutical Medication Review, Medication Interview Before Discharge and Follow-up: A Randomized Controlled Trial
Background
It is well known that the transfer of a patient from hospital to the general practitioner is
related with mistakes in the medication of the patient. A report from 2006 measure the number
of drug related admissions in Denmark to be 69.000 to 162.000 per year. To reduce these
mistakes, more and better communication between the health professionals are suggested.
Furthermore medication reviews made by pharmacist seems to reduce the number of drug related
readmissions and other drug related issues, which can lead to an economic cost reduction.
Objective
The aim of this study is to investigate the impact of medication review and better
communication between the health professionals after discharge of a patient from hospital to
the general practitioner. The effect is measured as reducing the number of readmissions and
number of visits at the emergency department 30 days and six month after inclusion of the
patient.
Method
This study was estimated to include 1500 participants. The patients were randomized to one of
three groups; usual care, basic intervention or extended intervention. The usual care
received the normal care following the Danish standard procedure. The basic intervention had
a medication review by a clinical pharmacist during admission.
The extended interventions group was similar to the basic intervention group plus follow-up
with the patient, the general practitioner and if relevant the nursing home and pharmacy one
week and six month after discharge by interview with the clinical pharmacist.
The aim of this study is to determine if a multifaceted pharmacist intervention based on
medication review, medication interview and follow up with patient, general practitioner and
pharmacy can reduce the number of readmissions and death and or if the time to next admission
can be postponed. The combination of the full pharmacist intervention is compared with
medication review alone in comparison to non-intervention.
Pharmacist intervention:
Usual care group: the patients received no intervention by the clinical pharmacist.
Basic intervention group: A structured, patient centered medication review (MR) was conducted
by the clinical pharmacist. The following was considered during MR: Were there untreated
diagnoses, has the goal of treatment been reached, was the treatment compliant with current
national guidelines regarding dose, choice of drug and time of treatment. Focus was at
certain drugs most commonly implicated in causing admission. Furthermore, all drugs on the
medication list were assessed according to the following: Indication for treatment, drug
dose, considering i.e. kidney insufficiency, age, etc., adverse drug events, therapeutic
duplication, dosage time and interval, drug formulation and strength, interactions,
contraindications, precautions and specific patient characteristics.
Advice on drug selection, dosages, monitoring needs and possibly side effects were given to
the physician in charge of the patient, and written in the electronic patient journal (EPJ).
Extended intervention group: MR was conducted according to the same terms and conditions as
for the basic intervention group. Upon discharge medication reconciliation was conducted. The
pharmacist provided a motivational interview (MI)-based patient interview including a
comprehensive summary of changes in the drug therapy during the hospitalization.
Post discharge any drug related problem not dealt with during hospitalization was mailed or
faxed to the general practitioner (GP). When needed, the GP, care giver and primary care
pharmacy were contacted by phone (approximately five working days after discharge).
Follow-up interview by phone was performed twice. The first was conducted one week post
discharge and the second six months after discharge. When needed additional follow-ups could
be made. The follow-up interviews had an motivational interview approach.
All interventions were conducted according to a defined standard operating procedure and all
interventions were performed by qualified clinical pharmacists from the involved sites. In
order to minimize the risk of cultural differences and variations in routine's the regions in
between, all data pharmacists were trained prior to entering the study.
Data was analysed after the intention-to-treat method. Data was analyzed after a proportional
hazard cox regression with the randomization group as the only variable.
;
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Recruiting |
NCT03456544 -
Vancomycin-Associated Acute Kidney Injury: A Cross-Sectional Study From a Multi- Center in China
|
||
| Recruiting |
NCT03086109 -
The Prevalence of Bone Degenerative Diseases in Beijing - a Cross-sectional Study
|
N/A | |
| Recruiting |
NCT04382534 -
A Cross-sectional and Cohort Study of COVID-19 Patients With Post - Discharge Dysfunction
|
||
| Not yet recruiting |
NCT06417151 -
Polish Infants and Toddler Nutritional Study
|
||
| Not yet recruiting |
NCT05668052 -
A Cross-sectional Study of Covid-19 Pandemic in Zhejiang Province
|
||
| Completed |
NCT03366987 -
Nonalcoholic Fatty Liver Disease is Associated With Increased Atrial Fibrillation Risk in an Elderly Chinese Population
|