Rationalisation of Polypharmacy by the RASP-instrument and Discharge Counselling of Geriatric Inpatients

Polypharmacy Clinical Trial

Official title:

Rationalisation of Polypharmacy by the RASP-instrument (Rationalisation of Home Medication by an Adjusted STOPP-list and Discharge Counselling of Geriatric Inpatients: a Prospective, Clinical Trial

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT05816967
• Other study ID #: S59694
• Status: Withdrawn
• Phase: N/A
• Start date: October 2018
• Est. completion date: September 2019

Study information

• Verified date: April 2023
• Source: Universitaire Ziekenhuizen KU Leuven
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Systematic evaluation of polypharmacy in geriatric patients, through a validated list by a clinical pharmacist. The goal is reduction of potentially inappropriate medications (PIMs). A brief counseling session with the patient and/or his/her caregiver will be part of the intervention.

Description:

This project is focused on the systematic evaluation of polypharmacy in older patients admitted to the acute geriatric wards of a university hospital. Polypharmacy will be identified through a validated list by a clinical pharmacist. The goal is reduction of potentially inappropriate medications (PIMs). Before hospital discharge the hospital pharmacist will have a brief counseling session with the patient and/or his/her caregiver in order to discuss the medication list and to enhance compliance.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: September 2019
• Est. primary completion date: September 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 75 Years and older

Eligibility

Inclusion Criteria:

• Informed consent by the patient and/or his/her caregiver

• Admission through the emergency department of patients coming from home or a residential care facility

Exclusion Criteria:

• Patients not speaking Dutch

• Patients admitted for end of life care

• Patients not taking any drugs on admission

Related Conditions & MeSH terms

• Polypharmacy

Intervention

Procedure:
• Medication review and discharge counseling
Medication reconciliation of home therapy will be performed by the clinical pharmacist through a standardized form. Next, the clinical pharmacist will perform a medication review, based on but not limited to the RASP list (Van der Linden 2014). The goal is optimization of therapy. Before discharge the clinical pharmacist will perform a second medication review, together with the treating physician and a medication reconciliation in orde to provide the best possible discharge medication list. The medication list will be provided 3 times: once for the patient and/or his/her caregiver, once for the general practitioner and once for the primary care pharmacist. Finally the clinical pharmacist will have a counseling session with the patient and/or his/her caregiver.

Locations

Country	Name	City	State
Belgium	UZLeuven	Leuven

Sponsors (1)

Lead Sponsor	Collaborator
Universitaire Ziekenhuizen KU Leuven

Country where clinical trial is conducted

Belgium, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Acceptance rate of the pharmacotherapeutic recommendations, provided by the clinical pharmacist by the general practitioner.	Acceptance rate of the pharmacotherapeutic recommendations, provided by the clinical pharmacist by the general practitioner.	1 month (30 days) after discharge
Primary	Acceptance rate of the pharmacotherapeutic recommendations, provided by the clinical pharmacist by the general practitioner.	Acceptance rate of the pharmacotherapeutic recommendations, provided by the clinical pharmacist by the general practitioner.	3 month (90 days) after discharge
Secondary	Number of drug intakes at discharge versus at admission.	Number of drug intakes at discharge versus at admission.	At discharge from the index hospitalization (as mentioned in the discharge medication scheme) vs on admission (during the first 72 hours of the index hospitalization)
Secondary	Number of drugs at discharge versus at admission.	Number of drugs at discharge versus at admission.	At discharge from the index hospitalization (as mentioned in the discharge medication scheme) vs on admission (during the first 72 hours of the index hospitalization)
Secondary	Number of drugs adapted by the treating physician based on recommendations by the clinical pharmacist that are not included in the RASP list.	Number of drugs adapted by the treating physician based on recommendations by the clinical pharmacist that are not included in the RASP list.	At discharge from the index hospitalization (as mentioned in the discharge medication scheme), compared to the medication list obtained on admission (this is, during the first 72 hours of the hospitalization)
Secondary	Difference in number of potentially inappropriate medications identified through the RASP list on admission versus at discharge	Difference in number of potentially inappropriate medications identified through the RASP list on admission versus at discharge	At discharge from the index hospitalisation (as mentioned in the discharge medication scheme) versus on admission (medication list obtained in the first 72 hours) of the index hospitalization
Secondary	Number of potentially inappropriate medications on admission, at discharge and at the follow-up moments (1 and 3 months after discharge)	Number of potentially inappropriate medications on admission, at discharge and at the follow-up moments (1 and 3 months after discharge)	On admission (medication list obtained in the first 72 hours of the admission), at discharge (as mentioned in the discharge medication scheme), 1 (30 days) month after discharge, 3 months (90 days) after discharge
Secondary	Mortality during admission	Mortality during admission	During the index hospitalization, from admission to the emergency ward until moment of death on the geriatric ward, assessed up to 72 hours after death.
Secondary	Number of falls during hospitalization	Number of falls during hospitalization	During the index hospitalization, from admission on the emergency ward until discharge from the geriatric ward, assessed within 72 hours after discharge.
Secondary	Number of fractures during hospitalization	Number of fractures during hospitalization	during the index hospitalization, from admission to the emergency ward until discharge from the geriatric ward, assessed within 72 hours after discharge.
Secondary	Length of stay	Length of stay	During the index hospitalization, from admission to the emergency ward until discharge from the geriatric ward, assessed within 72 hours after discharge.
Secondary	Readmission rate 3 months after discharge	Readmission rate 3 months after discharge	3 months (90 days) after discharge from the geriatric ward (index hospitalization), assessed at day 90
Secondary	Number of fractures at 3 months after discharge	Number of fractures at 3 months after discharge	3 months (90 days) after discharge from the geriatric ward (index hospitalization), assessed at day 90
Secondary	Number of falls 3 months after discharge	Number of falls 3 months after discharge	3 months (90 days) after discharge from the geriatric ward (index hospitalization), assessed at day 90
Secondary	Mortality at 3 months after discharge	Mortality at 3 months after discharge	3 months (90 days) after discharge from the geriatric ward (index hospitalization), assessed at day 90
Secondary	Category of potentially inappropriate medications identified through the RASP list on admission and at discharge	Category of potentially inappropriate medications identified through the RASP list on admission and at discharge	On admission (medication list obtained in the first 72 hours of the admission), at discharge (as mentioned in the discharge medication scheme)
Secondary	Category of drugs adapted by the treating physician based on recommendations by the clinical pharmacist that are not included in the RASP list.	Category of drugs adapted by the treating physician based on recommendations by the clinical pharmacist that are not included in the RASP list.	During the course of the index hospitalization, defined as the period between discharge from the geriatric ward and admission to the geriatric department. The outcome parameter will be assessed within 72 hours of discharge.
Secondary	Number of drugs at follow-up (1 month and 3 months after discharge)	Number of drugs at follow-up (1 month and 3 months after discharge)	1 month (30 days) and 3 months (90 days) after the index hospitalization
Secondary	Number of drug intakes at follow-up (1 month and 3 months after discharge)	Number of drug intakes at follow-up (1 month and 3 months after discharge)	1 month (30 days) and 3 months (90 days) after the index hospitalization