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| Name | Class |
|---|---|
| University of Padova | OTHER |
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Background and overall goal: Poor comprehension and medication adherence are common in older people, especially after hospitalizations, in case of changes or prescriptions of new therapeutic regimes. The aim of this project is to evaluate the effectiveness of a multidomain intervention with an integrated care approach, in improving medication adherence in older people after hospital discharge. A secondary aim is investigate the determinants of poor comprehension and medication adherence in such individuals.
Target population: The project will involve older patients hospitalized in a Geriatric Department and discharged at home, and (when present) their caregivers.
Methods and assessments: Upon hospital discharge, data from the comprehensive geriatric assessment and information on the present hospitalization and prescribed therapies will be collected for all participants. The comprehension of medical recommendations reported in the discharge summary will be evaluated for all patients/caregiver before and after the routine explanation by treating physicians. Participants will be then randomized in intervention vs. control group. The intervention will include: first, educational training of patients/caregivers at hospital discharge by a multidisciplinary team; second, after hospital discharge, a phone recall on the prescribed therapies and a one-week phone consultant service managed by a geriatrician, supported by the multidisciplinary team, to address potential concerns on prescribed treatments. Control group will follow usual care. After 7 days medication adherence will be assessed for both study groups through structured phone interviews. At 30 and 90 days from discharge, data on falls, rehospitalizations and vital status will be collected through hospital records.
Background and overall goal: Poor comprehension and medication adherence are common in older people, especially after hospitalizations, in case of changes or prescriptions of new therapeutic regimes. The aim of this project is to evaluate the effectiveness of a multidomain intervention with an integrated care approach, in improving medication adherence in older people after hospital discharge. Moreover, a secondary aim is to investigate the determinants of poor comprehension and medication adherence in such individuals.
Target population: The project will involve older patients hospitalized in a Geriatric Department and discharged at home, and (when present) their caregivers.
Methods and assessments: Upon hospital discharge, data from the comprehensive geriatric assessment and information on the present hospitalization and prescribed therapies will be collected for all participants. The comprehension of medical recommendations reported in the discharge summary will be evaluated for all patients/caregiver before and after the routine explanation by treating physicians. Participants will be then randomized in intervention vs. control group. The intervention will include: first, educational training of patients/caregivers at hospital discharge by a multidisciplinary team; second, after hospital discharge, a phone recall on the prescribed therapies and a one-week phone consultant service managed by a geriatrician, supported by the multidisciplinary team, to address potential concerns on prescribed treatments. Control group will follow usual care. After 7, 30 and 90 days, data on medication adherence, falls, rehospitalizations and vital status will be assessed for both study groups through structured phone interviews and hospital records.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Experimental | Patients hospitalized in the Geriatric Unit aged 60 years or older, that living in the community setting and who will be discharged at home and with expected survival >7 days. |
|
| Control group | No Intervention | Patients hospitalized in the Geriatric Unit aged 60 years or older, that living in the community setting and who will be discharged at home and with expected survival >7 days. The control group will be discharged following standard care procedures, and will receive only appropriate corrections and clarifications in case mistakes in the comprehension of the medical recommendations. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Educational training | Behavioral | The intervention will include: first, educational training of patients/caregivers at hospital discharge by a multidisciplinary team; second, after hospital discharge, a phone recall on the prescribed therapies and a one-week phone consultant service managed by a geriatrician, supported by the multidisciplinary team, to address potential concerns on prescribed treatments. |
| Measure | Description | Time Frame |
|---|---|---|
| Comprehension of medical recommendation at hospital discharge | number of mistakes in recalling the prescribed therapy | At baseline (corresponding to hospital discharge) |
| Adherence to medical recommendations given at hospital discharge | number of discrepancies in taking the prescribed therapy | 7 days after hospital discharge |
| Adherence to the recommendations provided by the occupational therapist at hospital discharge | number of days per week of recommendations' adherence | 7 days after hospital discharge |
| Measure | Description | Time Frame |
|---|---|---|
| Mortality | Assessment of vital status through hospital records and telephone interviews | 7, 30 and 90 days after hospital discharge |
| Number of falls | Evaluation through structured telephone interviews |
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For the enrolment of the study participants, we will regularly monitor ward admissions, and potential eligibility of the patients will be evaluated by using the following inclusion criteria:
Exclusion criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Giuseppe Sergi, MD, PhD | Contact | 0498218492 | giuseppe.sergi@unipd.it | |
| Caterina Trevisan, MD, PhD | Contact | 0532239572 | caterina.trevisan@unife.it |
| Name | Affiliation | Role |
|---|---|---|
| Cateriina Trevisan, MD, PhD | Università degli Studi di Ferrara | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Geriatric Unit of Ferrara Hospital | Recruiting | Ferrara | 44126 | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38687693 | Derived | Zanforlini BM, Sambo S, Devita M, Cignarella A, Vezzali F, Sturani S, Grandieri A, Noale M, Siviero P, Limongi F, Volpato S, Sergi G, Trevisan C; APPROACH working group. A multidisciplinary approach to improve adherence to medical recommendations in older adults at hospital discharge: The APPROACH study protocol. PLoS One. 2024 Apr 30;19(4):e0297238. doi: 10.1371/journal.pone.0297238. eCollection 2024. |
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| ID | Term |
|---|---|
| D055118 | Medication Adherence |
| ID | Term |
|---|---|
| D010349 | Patient Compliance |
| D010342 | Patient Acceptance of Health Care |
| D000074822 | Treatment Adherence and Compliance |
| D015438 | Health Behavior |
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| ID | Term |
|---|---|
| D014146 | Training Support |
| ID | Term |
|---|---|
| D005378 | Financial Support |
| D004467 | Economics |
| D004472 | Health Care Economics and Organizations |
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Participants will be randomized to the intervention vs. control group. The intervention will include: first, educational training of patients/caregivers at hospital discharge by a multidisciplinary team; second, after hospital discharge, a phone recall on the prescribed therapies and a one-week phone consultant service managed by a geriatrician, supported by the multidisciplinary team, to address potential concerns on prescribed treatments. Control group will follow usual care.
After 7 days medication adherence will be assessed for both study groups through structured phone interviews.
Over 30 and 90 days from discharge, data on falls, rehospitalizations and vital status will be collected through hospital records.
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| 30 and 90 days after hospital discharge |
| Number of emergency department visits | Evaluation through structured telephone interviews | 30 and 90 days after hospital discharge |
| Number of rehospitalizations | Evaluation through structured telephone interviews | 30 and 90 days after hospital discharge |
| Geriatric Unit of the Padua Central Hospital | Recruiting | Padova | 35128 | Italy |
|
| D001519 | Behavior |