Key result
Planned trial tests if clinical pharmacist intervention reduces 180-day drug-related readmissions in older adults.
Why the study?
Drug-related problems are a major cause of unplanned hospital admissions in elderly people, and transitions of care are a key target for improving patient safety.
Does a clinical pharmacist intervention reduce unplanned drug-related readmissions in elderly patients undergoing transitions of care?
RCT (n=700)
Two parallel arms
Does a clinical pharmacist intervention reduce unplanned drug-related readmissions in elderly patients undergoing transitions of care?
This study protocol outlines a randomized controlled trial to evaluate whether a clinical pharmacist intervention reduces drug-related hospital readmissions in elderly patients.
INTRODUCTION: Drug-related problems (DRPs) are a major cause of unplanned hospital admissions among elderly people, and transitions of care have been emphasised as a key area for improving patient safety. We have designed a complex clinical pharmacist intervention that targets people ≥75 years of age undergoing transitions of care from hospital to home and primary care. The main objective is to investigate if the intervention can reduce the risk of unplanned drug-related readmission within the first 180 days after the person is discharged from hospital. METHODS AND ANALYSIS: This is a randomised, controlled, superiority trial with two parallel arms. A total of 700 people ≥75 years will be assigned to either intervention or routine care (control). The intervention, which aims to find and manage DRPs, is initiated within a week of the person being discharged from hospital and combines repeated medical chart reviews, phone interviews and in some cases medication reviews. People in both study arms may have been the subject of a medication review during their ward stay. As the primary outcome, we will measure time until unplanned drug-related readmission within 180 days of leaving hospital and use log rank tests and Cox proportional hazard models to analyse differences between the groups. Further investigations of subgroup effects and adjustments of the regression models will be based on heart failure and cognitive impairment as prognostic factors. ETHICS AND DISSEMINATION: The study has been approved by the Regional Ethical Review Board in Umeå (registration numbers 2017-69-31M, 2018-83-32M and 2018-254-32M). We intend to publish the results with open access in international peer-reviewed journals and present our findings at international conferences. The trial is expected to result in more than one published article and form part of two PhD theses. TRIAL REGISTRATION NUMBER: NCT03671629.
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Kindstedt et al. (2020) conducted an RCT in Drug-related problems in transitions of care (n=700). Clinical pharmacist intervention vs. Routine care was evaluated on Time until unplanned drug-related readmission within 180 days of leaving hospital. A planned randomized controlled trial of 700 patients ≥75 years will investigate if a clinical pharmacist intervention reduces unplanned drug-related readmissions within 180 days of hospital discharge.
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