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Elderly patients have a higher risk of experiencing adverse drug events due to an age related increase in morbidity and medication use. Inappropriate or wrong medication use among elderly patients acutely admitted to hospitals is assumed to result in earlier contact to general practitioner, emergency departments and re-admissions if not corrected during hospital admission. It is therefore our hypothesis that a systematic medication review conducted by pharmacists and physicians specialized in pharmacology will increase time to first unscheduled physician contact (general practitioner, emergency departments, ambulatory care and re-admissions) after discharge from hospital from an average of 21days to 25 days. Further, the following secondary outcome parameters will be measured at discharge and within 3-month follow-up:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention | Other | Systematic medication review |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Systematic medication review and advisory notes | Other | Within 24 hours of admission a pharmacist retrieve medication histories from patients included in the intervention group. Medication histories will be obtained from - medical records, medication charts, patients electronical medication profile, interview with patients and if necessary contact to the patients general practitioner. The obtained medication history will be discussed with a physician specialized in pharmacology and an advisory note with suggested changes to the patients medication is added to the medical record. The orthopedic physicians are not obliged to follow the suggested changes |
| Measure | Description | Time Frame |
|---|---|---|
| Time to first unscheduled physician contact(general practitioner,emergency department, ambulatory care or re-admission to hospital) after discharge from the Orthopaedic Department | January 2010 |
| Measure | Description | Time Frame |
|---|---|---|
| Admission time | October 2009 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Nielsen Lars Peter, Assoc. Prof. | Aarhus University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Regional hospital, Randers | Randers | Central Jutland | 8900 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18093253 | Background | Holland R, Desborough J, Goodyer L, Hall S, Wright D, Loke YK. Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis. Br J Clin Pharmacol. 2008 Mar;65(3):303-16. doi: 10.1111/j.1365-2125.2007.03071.x. Epub 2007 Dec 17. | |
| 10848724 | Background |
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| Lau HS, Florax C, Porsius AJ, De Boer A. The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards. Br J Clin Pharmacol. 2000 Jun;49(6):597-603. doi: 10.1046/j.1365-2125.2000.00204.x. |
| 16047138 | Background | Glintborg B, Andersen SE, Dalhoff K. Drug-drug interactions among recently hospitalised patients--frequent but mostly clinically insignificant. Eur J Clin Pharmacol. 2005 Oct;61(9):675-81. doi: 10.1007/s00228-005-0978-6. Epub 2005 Oct 19. |
| 17296535 | Background | Page RL 2nd, Ruscin JM. The risk of adverse drug events and hospital-related morbidity and mortality among older adults with potentially inappropriate medication use. Am J Geriatr Pharmacother. 2006 Dec;4(4):297-305. doi: 10.1016/j.amjopharm.2006.12.008. |
| 16585113 | Background | Vira T, Colquhoun M, Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006 Apr;15(2):122-6. doi: 10.1136/qshc.2005.015347. |