Drug-Related Side Effects and Adverse Reactions Clinical Trial
Official title:
Impact of Clinical Pharmacist on Post-discharge Prevention of Adverse Drug Events in Older Adults: Randomized Clinical Trial.
Adverse drug events (ADE) are one of the major problems affecting quality of care and
achievement of therapeutic goals in older adults (OA), increasing re-admissions, hospital
stays, resource use, and problems on patient safety. The present study aim is to determine
the impact of the clinical pharmacist interventions on the prevention of ADE in OA at 3
months post-discharge compared to usual care.
A randomized clinical trial of two parallel groups 1: 1 (control and intervention) plus a
historical control group will be carried out at the Internal Medicine Service (IMS) of the
teaching Hospital at the University of Chile. The sample will be of 611 patients (242 per
each parallel group and 127 of the historical control group) of 60 years or older, admitted
to the IMS for acute pathology or decompensation of chronic pathology, with survival over 6
months, who is under pharmacological therapy and have a caretaker or responsible contact
person at discharge.
The historical control group will receive usual care and the parallel control group will
also receive training on pharmacogeriatrics. The intervention group will receive the care of
a clinical pharmacist during hospitalization, at discharge and post-discharge, through a
home visit at 30 days post-discharge and a telephone call at 60 days post discharge.
The intervention plan during hospitalization will consist of daily monitoring of
pharmacological efficacy and safety, participating in clinical rounds and patient
interviews. To review, assess the indications according to the conditions of each patient
and evaluating possible interactions of clinical importance, dose adjustments, potentially
inappropriate medication for older adult (OA), adverse effects and omissions of therapy. To
make recommendations to the healthcare team regarding pharmacological therapy received
during hospitalization and at discharge.
Patient-directed interventions will occur at discharge and post-discharge, focusing on
clarifying management regimens, drug use motives, preventing drug-related problems,
clarifying doubts and educating on pharmacotherapy, and enhancing adherence to treatment.
The selection and recruitment of the patients will be made during the first 48 hours of
their admission to the Internal Medicine Service (IMS), where they will be invited to
participate and sign the informed consent.
In all groups, a physician, pharmacist, and occupational therapist, blind to treatment
assignment, will collect sociodemographic, morbid, pharmacotherapeutic, and functional
(Barthel Index and Lawton & Brody Scale), adherence (Morisky & Green Scale), delirium
(Confusion Assessment Method, CAM), comorbidity (cumulative illness rating scale in
Geriatrics (CIRS-G)), anticholinergic burden (Anticholinergic Burden Scale and Ars Risk
Scale), potentially inappropriate medications (Beers Criteria and screening tool of older
people's prescriptions & screening tool to alert to right treatment criteria (STOPP &
START)) before, during hospitalization, at discharge and post-discharge. Also a follow up by
telephone interviews at 30, 60 and 90 days after hospital discharge from the IMS.
Two trained and independent evaluators (geriatrician and clinical pharmacist), blind to
treatment assignment, will evaluate the history of each case and by consensus will assign
the presence of Adverse Drug Events (ADE), and classify them as preventable or not and
according to severity. The Chi-squared or Fisher exact test will be used to test the
hypothesis that clinical pharmacist intervention prevents at least 50% of ADE at 3 months
post-discharge in OA compared to usual care in the IMS.
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