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Diabetes mellitus (DM) is associated with the frequent use of polypharmacy at different times of administration and requires special attention from the patient or caregivers in order to properly treatment performed. The degree of Functional Literacy in Health is defined as the ability to apply literacy skills to health-related materials, including prescriptions, package inserts, and home care instructions. Several questionnaires are used in research and clinical practice to assess the pronunciation and understanding of commonly used medical terms, as the SAHLPA-18 (Short Assessment of Health Literacy for Portuguese Speaking Adults). The Brief Medication Questionnaire (BMQ) evaluates adherence to medication use from a patient's perspective.
During the basal visit, after the characterization of the sample (n= 100), inpatients from Hospital de ClÃnicas de Porto Alegre (HCPA) were randomized to interventional or comparator group. The interventional group was follow up during a year after basal discharge. Comparator group received only a phone call, 30 days after the basal discharge, to question how was their healthy status. Readmission rates were evaluated for both groups. Also, a economic evaluation was made to measure the readmission rates in terms of costs.
The first outcome of the clinical study was to measure the readmission rate through a structured pharmaceutical care model after basal hospital discharge and measure the effect of this intervention in terms of readmission reduction in a short term period of 30 days, regardless of the hospitalization reason.
As secondary outcomes the investigators measured the readmission rates after basal hospital discharge and the effect of the intervention in terms of readmission reduction in 60, 90,180 and 365 days after basal hospital discharge. Also, the readmission costs in terms of cost-effectiveness were evaluate.
The sample consisted of 100 patients with DM associated with other comorbidities, hospitalized for any reason in the HCPA, of both sexes, older than 18 years.
Informed consent, demographic and validated questionnaires data were collected in the basal visit. After that, patients were randomized to:
Group 1: comparator; Group 2: structured pharmaceutical intervention.
Seven days after basal hospital discharge, drugs adherence was verified.
The interventional group received pharmaceutical care at basal hospitalization stay, after randomization, have their prescription reviewed until 7 days after discharge of basal hospitalization and also received structured phone calls and mobile SMS (Short Message Service) during one year follow up (30, 60, 180 and 365 days).
Electronic medical records of the included patients (intervention and comparator groups) were reviewed monthly for 12 months, aiming to identify access to emergency services or hospital readmissions at the HCPA and, consequently, the reasons for readmissions and outcomes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Structured pharmaceutical care | Experimental | Patients receive a structured pharmaceutical care until one year after hospital discharge |
|
| Comparator group | Active Comparator | Patient received a single phone call 30 days after basal hospital discharge. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Structured pharmaceutical care | Behavioral | Patients receive a structured pharmaceutical care from one year after basal hospital discharge |
|
| Measure | Description | Time Frame |
|---|---|---|
| Short term readmission rate | Hospital readmissions after basal hospital discharge | 30 days after basal hospital discharge |
| Measure | Description | Time Frame |
|---|---|---|
| Readmission rate - 60 days | Hospital readmissions after basal hospital discharge | 60 days after basal hospital discharge |
| Readmission rate - 90 days | Hospital readmissions after basal hospital discharge |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ticiana C Rodrigues, PhD | Federal University of Health Science of Porto Alegre | Principal Investigator |
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| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| ID | Term |
|---|---|
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
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Randomized clinical trial study
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The outcomes assessor made a blind evaluation from the study outcomes.
| Comparator | Behavioral | Patient received a single phone call 30 days after basal hospital discharge. |
|
| 90 days after basal hospital discharge |
| Long term readmission rate- 180 days | Hospital readmissions after basal hospital discharge | 180 days after basal hospital discharge |
| Long term readmission rate- 365 days | Hospital readmissions after basal hospital discharge | 365 days after basal hospital discharge |
| Economic evaluation | Comparison between costs from readmission in both randomized groups | 365 days |