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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT02094040
Other study ID # 3800H0.52-0059
Secondary ID
Status Completed
Phase N/A
First received March 12, 2014
Last updated March 19, 2014
Start date February 2012
Est. completion date December 2013

Study information

Verified date March 2014
Source Holbaek Sygehus
Contact n/a
Is FDA regulated No
Health authority Denmark: Danish Dataprotection Agency
Study type Interventional

Clinical Trial Summary

The purpose of this study is to determine whether discharge follow-up visit by primary physician and community-based nurse affects the risk of early re-hospitalisation among high risk older people discharged from a medical ward.


Recruitment information / eligibility

Status Completed
Enrollment 531
Est. completion date December 2013
Est. primary completion date December 2013
Accepts healthy volunteers No
Gender Both
Age group 65 Years and older
Eligibility Inclusion Criteria:

- Patient geography (The participant live in; Holbæk Kommune, Odsherred Kommune or Kalundborg Kommune.)

- Discharged from medical ward Holbæk Sygehus.

- Frailty (Rated by following criterion: dementia or a minimum of two of the following conditions; two or more hospitalisations within 12 month prior to follow up, los of physical function, treatment of two or more concurrent medical and/or surgical conditions, psychiatric disease, multi-pharmacy of more than 6 prescription medication, suspicious of congenital disturbances, substance abuse problem, disadvantaged social network, need for increasing home care following index hospitalization.)

Exclusion Criteria:

- Not discharged to home (If the patient are not discharged to home.)

- No written consent (If the patient does not wish to participate / written consent are not signed.)

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Investigator), Primary Purpose: Prevention


Related Conditions & MeSH terms


Intervention

Behavioral:
Receive municipality-based follow-up visit
Systematic electronic referral from hospital to municipality of high risk people at discharge from a medical ward. Contact from municipality service to primary physician and citizen, to arrange first home visit within 7 days with focus on: medication, rehabilitation plan and health care appointments, functional level and need for further health care initiatives. The visit is concluded by planning of further visits (up till tree) and division of responsibilities between primary physician and the municipality service.

Locations

Country Name City State
Denmark Medicinsk Afdeling, Holbæk Sygehus Holbæk

Sponsors (3)

Lead Sponsor Collaborator
Holbaek Sygehus Danish Institute for Public Health, Region Sjælland

Country where clinical trial is conducted

Denmark, 

Outcome

Type Measure Description Time frame Safety issue
Other Long-term death rate Other pre-specified outcome concerns death rate measured at 30 and 180 days post discharge. Data is obtained from the official register of Danish patients (Landspatientregistret). Within 180 days from discharge Yes
Other Long-term use of primary health care services Other pre-specified outcome concerns the use of primary health care services measured at 30 and 180 days post discharge. Data is obtained from the official register of primary health care in Denmark (Sygesikringsregistret) and registration from 3 Danish municipalities. Within 180 days from discharge No
Other Long-term use of secondary health care services Other pre-specified outcome concerns the use of secondary health care services measured at 30 and 180 days post discharge. Data is obtained from the official register of Danish patients (Landspatientregistret). Within 180 days from discharge No
Primary Re-admission The primary outcome is re-hospitalisation rate within 30 days from discharge. Data is obtained from the official register of danish patients (Landspatientregistret). Within 30 days from discharge Yes
Secondary Long-term hospitalization rate Secondary outcome concerns hospitalization rate measured at 30 and 180 days post discharge. Data is obtained from the official register of Danish patients (Landspatientregistret). Within 180 days from discharge Yes
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