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| Name | Class |
|---|---|
| University Hospital of North Norway | OTHER |
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Suboptimal use of medications among geriatric patients is well-known problem and leads to medication errors, re-hospitalizations and death. By using a randomized controlled trial (RCT) design the investigators aim to explore a new inter-professional working structure. The working structure is based on the scientifically and clinically acknowledged integrated medicines management (IMM) model. The overall aim of the study is to explore the effect of the new working structure on the composite endpoint re-hospitalization + visit to an emergency department during 12 months after hospital discharge.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard care | No Intervention | The study participants receives standard care in the ward, this does not include a pharmacist. | |
| Intervention | Experimental | Interdisciplinary collaboration structure |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Interdisciplinary collaboration structure | Other | A pharmacist is integrated in the team surrounding the patient, working by the Integrated Medicines Management (IMM) model. The IMM-model consist of medication reconciliation, medication review, standardized medication reports and counseling patients about their medication at discharge. In addition a phone meeting between the primary care physician and the study pharmacist is added after discharge. |
| Measure | Description | Time Frame |
|---|---|---|
| Emergency medical visits | Rate of emergency Medical visits at 12 months. Emergency Medical visits is a composite endpoint including emergency department visits and unscheduled hospitalization | 12 months after hospital discharge |
| Measure | Description | Time Frame |
|---|---|---|
| Self-reported quality of life | Change in self-reported quality of life using the validated EQ-5D | 1 months after hospital discharge |
| Self-reported quality of life | Change in self-reported quality of life using the validated EQ-5D |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Beate H Garcia, PhD | UiT The artic university of Norway | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University hospital of North Norway | Tromsø | 9030 | Norway |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29362276 | Background | Johansen JS, Havnes K, Halvorsen KH, Haustreis S, Skaue LW, Kamycheva E, Mathiesen L, Viktil KK, Granas AG, Garcia BH. Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (IMMENSE study): study protocol for a randomised controlled trial. BMJ Open. 2018 Jan 23;8(1):e020106. doi: 10.1136/bmjopen-2017-020106. | |
| 38884880 |
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|
| 6 months after hospital discharge |
| Self-reported quality of life | Change in self-reported quality of life using the validated EQ-5D | 12 months after hospital discharge |
| length in days of index hospital stay | Days from hospital admission to discharge of index hospital stay | Days from hospitalization to discharge of index hospital stay, assessed up to 12 months |
| Time to first rehospitalization | Days to first hospitalization | First rehospitalization after discharge from index hospital stay, up to 12 months after discharge. |
| Visits to primary care physician | Visitation rate at 12 months | 12 months after discharge for index hospital stay |
| Mortality rate | 12 months after randomization |
| Total score of the Medication appropriateness index (MAI) | Baseline at randomization |
| Change in total score of the Medication appropriateness index (MAI) | From baseline to date of discharge from hospital, assessed up to 12 months |
| Inappropriate medications identified through the Norwegian general practice criteria (NORGEP) | Baseline at randomization |
| Change in Inappropriate medications identified through the Norwegian general practice criteria (NORGEP) | From baseline to date of discharge from hospital, assessed up to 12 months |
| Change in inappropriate medications identified through the Norwegian general practice criteria (NORGEP) | From baseline to 3 months after discharge from index hospital stay, assessed up to 12 months |
| Potentially inappropriate prescribing identified through the Screening Tool to Alert doctors to Right treatment (START) | Baseline at randomization |
| Change in potentially inappropriate prescribing identified through the Screening Tool to Alert doctors to Right treatment (START) | From baseline to date of discharge from hospital, assessed up to 12 months |
| Potentially inappropriate prescribing identified through the Screening Tool of Older Persons' Prescriptions (STOPP) | Baseline at randomization |
| Change in potentially inappropriate prescribing identified through the Screening Tool of Older Persons' Prescriptions (STOPP) | From baseline to date of discharge from hospital, assessed up to 12 months |
| Change in potentially inappropriate prescribing identified through the Screening Tool of Older Persons' Prescriptions (STOPP) | From baseline to 12 months after discharge from hospital |
| Changes in medication, identified through screening of drug lists at their primary care physician. | Drug changes made during hospitalization implemented by the primary care physician. | 12 months after discharge from index hospital stay |
| Changes in medication, identified through screening of drug lists at their primary care physician. | Drug changes made during hospitalization implemented by the primary care physician. | 3 months after discharge from index hospital stay |
| Rehospitalizations where the reason for hospitalization is possibly, probably or certainly drug-related. | A chart review will be done retrospectively to evaluate if the patients first rehospitalization was drug related or not. Classified by a multiprofessional team of experts | First rehospitalization after discharge from index hospital stay, up to 12 months after inclusion in study |
| Hip fracture | Rate of hip fractures | 12 months after discharge from index hospital stay |
| Stroke | Stroke rate during 12 months follow-up | 12 months after discharge from index hospital stay |
| The proportion of patients readmitted acutely within 30 days | 30 days after discharge from index hospital stay |
| Robinson EG, Gyllensten H, Granas AG, Halvorsen KH, Garcia BH. Health-related quality of life among older adults following acute hospitalization: longitudinal analysis of a randomized controlled trial. Qual Life Res. 2024 Aug;33(8):2219-2233. doi: 10.1007/s11136-024-03689-x. Epub 2024 Jun 17. |
| 37991657 | Derived | Robinson EG, Gyllensten H, Johansen JS, Havnes K, Granas AG, Bergmo TS, Smabrekke L, Garcia BH, Halvorsen KH. A Trial-Based Cost-Utility Analysis of a Medication Optimization Intervention Versus Standard Care in Older Adults. Drugs Aging. 2023 Dec;40(12):1143-1155. doi: 10.1007/s40266-023-01077-7. Epub 2023 Nov 22. |
| 36289541 | Derived | Johansen JS, Halvorsen KH, Svendsen K, Havnes K, Robinson EG, Wetting HL, Haustreis S, Smabrekke L, Kamycheva E, Garcia BH. Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study) - a randomized controlled trial. BMC Health Serv Res. 2022 Oct 26;22(1):1290. doi: 10.1186/s12913-022-08648-1. |