Medication Reconciliation Clinical Trial
Official title:
Impact of Routine Pharmacist-led Medication Reconciliation on Medication Discrepancies and Post-hospital Healthcare Utilisation
Verified date | January 2024 |
Source | The University Clinic of Pulmonary and Allergic Diseases Golnik |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Background: Transitions of care often lead to medication errors and unnecessary healthcare utilisation. It has been repeatedly shown that medication reconciliation can at least partially reduce this risk. Objective: The aim of this prospective pragmatic trial was to evaluate the effectiveness of pharmacist-led medication reconciliation offered to medical patients as part of routine clinical practise. The main questions to be answered were: - the effectiveness of pharmacist-led medication reconciliation on medication discrepancies at discharge and 30 days after discharge - the effectiveness of pharmacist-led medication reconciliation on healthcare utilisation within 30 days after discharge. Participants in the intervention group were offered the following: - medication reconciliation on admission - medication reconciliation on discharge, coupled with patient counselling, provided by clinical pharmacists. Participants in the control group were offered standard care.
Status | Terminated |
Enrollment | 553 |
Est. completion date | December 31, 2020 |
Est. primary completion date | October 18, 2020 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - All adult medical patients admitted to the study wards Exclusion Criteria: - patients who do not speak Slovenian, - transferred from another ward, - previously included in the same study. Subsequent exclusion from the analysis: - patients hospitalised only for diagnostic purposes, - patients transferred to another ward or hospital, - patients that died during hospitalisation, - patients from the control group who were offered medication reconciliation |
Country | Name | City | State |
---|---|---|---|
Slovenia | University Clinic of Respiratory and Allergic Diseases Golnik | Golnik | Select State |
Lead Sponsor | Collaborator |
---|---|
The University Clinic of Pulmonary and Allergic Diseases Golnik | University of Ljubljana |
Slovenia,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Unplanned healthcare utilisation within 30 days after discharge | Unplanned healthcare utilisation within 30 days of hospital discharge was defined as any unplanned visit to a general practitioner, specialist, emergency department (ED), or hospitalisation or death. The visits were classified as unplanned, if sudden health problems required medical attention, and planned, if scheduled. Data on mortality due to any reason were also collected 30 days after discharge. For each patient, only the most detrimental outcome was classified. | within 30 (±5) days after hospital discharge | |
Secondary | Serious unplanned healthcare utilisation within 30 days after discharge | Serious unplanned healthcare utilisation were defined as any unplanned ED visit or hospitalisation or death within 30 days from hospital discharge. | within 30 (±5) days after hospital discharge | |
Secondary | Clinically important medication errors at discharge | Unintentional discrepancies and undocumented intentional discrepancies between the therapy the patient was taking before admission (BMPH) and the therapy recommended in the discharge letter were defined as medication errors. Their clinical importance was assessed using a 4-point Likert scale ranging from not important, not very important, very important to life-threatening medication errors. Very important and life-threatening medication errors represent clinically important medication errors. | On the day of hospital discharge (up to 365 days from hospital admission) | |
Secondary | Medication discrepancies at 30 days | Medication discrepancies 30 (±5) days after hospital discharge were defined as the discrepancies between the discharge therapy and the therapy the patient was taking 30 (±5) days after hospital discharge.
The discrepancies were defined as intentional if the patient intentionally took the therapy differently than recommended in the discharge letter. The reason for the discrepancy was also recorded - the patient's own informed decision or due to instructions from the treating physician (general practitioner, specialist). Unintentional discrepancies were defined as discrepancies from the therapy recommended in the discharge letter of which the patients were unaware. The clinical importance of unintentional discrepancies was assessed using a 4-point Likert scale, ranging from not important, not very important, very important, to life- threatening. |
At 30 (±5) days after hospital discharge | |
Secondary | All healthcare utilisation within 30 days after discharge | Healthcare visits within 30 days of hospital discharge were defined as any visit to a general practitioner, specialist, emergency department (ED), or hospitalisation. These visits were classified as unplanned, if sudden health problems required medical attention, and planned, if scheduled. Data on mortality due to any reason were also collected 30 days after discharge. For each patient, only the most detrimental outcome was classified. | within 30 (±5) days after hospital discharge |
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