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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT01897870
Other study ID # ZGA-1
Secondary ID
Status Completed
Phase N/A
First received July 2, 2013
Last updated February 22, 2016
Start date November 2013
Est. completion date February 2016

Study information

Verified date February 2016
Source Zorggroep Almere
Contact n/a
Is FDA regulated No
Health authority Netherlands: Medical Ethics Review Committee (METC)Netherlands: The Central Committee on Research Involving Human Subjects (CCMO)
Study type Interventional

Clinical Trial Summary

the purpose of this study is to determine the the effect of a home-based medication management program on drug-related problems post-discharge.


Description:

Inaccuracy of medication histories and lack of knowledge on actual medication use results in confusion about medication regimens and medication mismanagement before- during - and after hospital admission. This phenomenon accounts for many readmissions, longer duration of admission and preventable and serious Adverse Drug Events (ADEs) as a result of Drug Related Problems (DRPs). Several studies show that discharge medication reconciliation (MR) and counseling by a pharmacy employee reduces the amount of discrepancies in the discharge prescription lists. Still, no unequivocal effect of MR on the occurrence of DRPs after discharge has been shown. This is due to a shift in underlying potential harmful discrepancies from mainly patient based (unintended nonadherence) to mainly system based (eg dispensing errors) and might be explained by (1) suboptimal transfer of information (2) an overload of information during a stressful situation and (3) difficulty to implement changes in medication at home. Therefore the reduction of DRPs, improvement of patients' medication knowledge and initial adherence can probably most effectively be addressed in a multifaceted integrated transmural intervention. Repetition of important information is the key to success. Moreover, the first weeks following hospital discharge are most crucial in preventing drug-related problems as patients could slip back in old medication schemes, or new problems may arise, such as emerging ADEs due to medication changes made during hospitalization.


Recruitment information / eligibility

Status Completed
Enrollment 150
Est. completion date February 2016
Est. primary completion date February 2016
Accepts healthy volunteers No
Gender Both
Age group 18 Years and older
Eligibility Inclusion Criteria:

- patient uses more than three prescribed systemic drugs intended for chronic use at admission and discharge

- patient has an expected length of stay of 48 hours or longer

Exclusion Criteria:

- Patients admitted for scheduled chemotherapy

- Patients admitted for radiation therapy

- Patients admitted for transplantation

- Patients transferred from another hospital

- Patients transferred from another non-eligible ward within the same hospital

- No informed consent signed

- A live expectancy less than 6 months

- Inability to be counselled (e.g. cognitive dysfunction, language constraints who cannot be solved with an interpreter)

- Discharge to a nursing home (presuming dependence on medication administration)

- If patients' community pharmacy is not participating in this study

Study Design

Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Supportive Care


Related Conditions & MeSH terms


Intervention

Behavioral:
HomeCoMe-program
A home visit by patients own community pharmacist within seven days after hospital discharge. The community pharmacist will perform a semi-structured interview on (1) use of the prescribed medication, (2) ADEs, (3) adherence issues, by (A) assessing patient's needs and concerns around his pharmacotherapy, (B) identifying and solving obstacles for medicines intake, (C) checking on the need for a compliance aid, (D) collecting spare medication and finally (4) knowledge on medication use, when to take which medicine and why, and medication changes made during the hospitalisation.

Locations

Country Name City State
Netherlands Zorgapotheken Flevoland Almere Flevoland

Sponsors (3)

Lead Sponsor Collaborator
H.T. Ensing, PharmD, MSc Flevoziekenhuis, Almere, Zorggroep Almere

Country where clinical trial is conducted

Netherlands, 

References & Publications (3)

Al-Rashed SA, Wright DJ, Roebuck N, Sunter W, Chrystyn H. The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol. 2002 Dec;54(6):657-64. — View Citation

Kwint HF, Faber A, Gussekloo J, Bouvy ML. The contribution of patient interviews to the identification of drug-related problems in home medication review. J Clin Pharm Ther. 2012 Dec;37(6):674-80. doi: 10.1111/j.1365-2710.2012.01370.x. Epub 2012 Aug 3. — View Citation

Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, Kachalia A, Horng M, Roy CL, McKean SC, Bates DW. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006 Mar 13;166(5):565-71. — View Citation

Outcome

Type Measure Description Time frame Safety issue
Primary Identifying and solving adverse drug events (ADEs) and other drug-related problems (DRPs) post-discharge The total number of assessed and solved ADEs post-discharge will be measured. Assessing and solving ADEs takes place during the pharmacist home visit.
Using START-STOPP criteria on patients medication records, ADEs will also be compared between the intervention and usual care group.
within 7 days post-discharge No
Secondary Improvement of adherence to medication at hospital discharge The "medication possession ratio" will be calculated retrospectively from pharmacy dispensing data after 6 months to investigate patient's adherence and compared between the intervention and control group. up to 6 months after discharge No
Secondary Patient assessment of medication knowledge at time of home visit At time of the home visit patients are asked about their knowledge (e.g. indication, dose regime, etc) regarding the medication they are taking. Knowledge is scored and lack of knowledge is solved by teaching the patient. within 7 days after discharge No
Secondary Types of interventions made at the pharmacist home visit The types of intervention the pharmacist works on during the 7 day follow-up home visit are assessed. within 7 days after discharge No
Secondary Patient satisfaction with the pharmacist home visit The satisfaction survey consists of 13 interview questions, where the subject subjectively scores each question on a four-point scale, developed specifically for this study. Immediately after receiving the home visit No
Secondary Assessment of patient reported health rating Patient are asked by telephone to report their health on a scale from 1 (worst imaginable health) to 10 (best imaginable health). Number are compared between the intervention and control group. at 14 days after discharge No
Secondary General practitioners satisfaction with the pharmacist home visit The satisfaction survey consists of 13 interview questions, where the subject subjectively scores each question on a four-point scale, developed specifically for this study. Immediately after the home visit is executed No
Secondary Assessment of patient reported health rating Patient are asked by telephone to report their health on a scale from 1 (worst imaginable health) to 10 (best imaginable health). Number are compared between the intervention and control group. at 42 days after discharge No
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