NCT05799430

Medication Review in Chronic Complex or Polymedicated Patients After Hospital Discharge.

Effects of Interdisciplinary Medication Review in Chronic Complex Patients or Patients With Polypharmacy After Hospital Discharge

• Status: Unknown
• Phase: N/A
• Study type: Interventional
• Enrollment: 372 (estimated)
• Sponsor: Fundación Pública Andaluza para la gestión de la Investigación en Sevilla · Academic / Other
• Sex: All
• Age: 65 Years
• Healthy volunteers: Not accepted

Summary

The goal of this prospective multicentre clustered randomized controlled trial is to evaluate the effect on new hospitalization episodes of a multidisciplinary medication review in primary care patients with polypharmacy or chronic complex conditions after hospital discharge. The multidisciplinary team will be integrated by a family physician (FP), a primary care nurse (PCN) and a primary care pharmacist (PCP). Patient will be adults aged 65 years and older. Polypharmacy refers to the use of 10 or more drugs based on information in electronic prescription software. Research questions are: In elderly patients with polypharmacy, which is the effect of an interdisciplinary medication review after hospital discharge in comparison with standard care, in terms of: * new hospitalization episodes? * number of drugs prescribed? * prescribed drugs adequacy?

Detailed description

Centres will be randomized to medication review intervention or usual care group. Eligible patients will be ask for informed consent. For patients in the intervention group, PCP will collect information about prescribed medication and diseases from the electronic health record and e-prescribing application. The medication review in primary care will be focus to reconcile the medications the patient was taking prior to admission and those initiated in hospital, with the medications they should be taking post-discharge to ensure all changes are intentional and that discrepancies are resolved as soon as possible. The review process will include detection of potential drugs interactions, wrong doses, lack of adherence (based on dispensing recorded data) and adequacy to explicit criteria for potentially inappropriate prescriptions included in different tools: a) STOPP-STAR, STOPP-Pal, LESS-CHRON lists; b) Guideline for Medication Review in Primary Care, a local publication and c) Medication review in patients with polypharmacy. A list of drugs frequently associate with potentially inappropriate prescriptions. Andalusian health Service). PCP will write a report to communicate the results of medication review to primary care physician and nurse. The multidisciplinary team will define a personalized therapeutic plan to be implemented for every patient. Patients in the control group will receive usual care.

Conditions

• Medication Review
• Polypharmacy
• Disease, Chronic

Interventions

Type	Name	Description
BEHAVIORAL	Multidisciplinary medication review	FP communicate to the PCP patients recently discharged. The medication review process consists in 5 steps: 1. PCP perform a structured drug review based on information from health record and e-prescribing application. The drug review comprise the appraisal of potentially inappropriate medication based on lists of explicit criteria. 2. PCP communicates and discuss the results of medication review with GP and PCN, in a brief meeting face-to-face, with possible adaptation of the recommendations. 3. FP, PCN and PCP agree on a personalized therapeutic plan for the patient that includes actions to optimize the therapy. 4. FP and PCN share plan with the patient and/or carer with possible adaptation of the recommendations and agree about actions to be implemented. 5. FP and PCN communicate to PCP final agreement with patient and/or carer 6. FP and/or PCN follow-up implantation of agreed recommendations using standard health care procedures
BEHAVIORAL	Control group	Usual care by FP an PCN

Timeline

• Start date: 2023-04-15
• Primary completion: 2024-06-10
• Completion: 2024-07-31
• First posted: 2023-04-05
• Last updated: 2023-09-15

Locations

1 site across 1 country: Spain