Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT.

Grischott, Thomas; Zechmann, Stefan; Rachamin, Yael; Markun, Stefan; Chmiel, Corinne; Senn, Oliver; Rosemann, Thomas; Rodondi, Nicolas; Neuner-Jehle, Stefan (2018). Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT. Implementation Science, 13(1), p. 155. BioMed Central 10.1186/s13012-018-0839-1

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BACKGROUND Inappropriate medication and polypharmacy increase morbidity, hospitalisation rate, costs and mortality in multimorbid patients. At hospital discharge of elderly patients, polypharmacy is often even more pronounced than at admission. However, the optimal discharge strategy in view of sustained medication appropriateness remains unclear. In particular, unreflectingly switching back to the pre-hospitalisation medication must be avoided. Therefore, both the patients and the follow-up physicians should be involved in the discharge process. In this study, we aim to test whether a brief medication review which takes the patients' priorities into account, combined with a standardised communication strategy at hospital discharge, leads to sustained medication appropriateness and extends readmission times among elderly multimorbid patients. METHODS The study is designed as a two-armed, double-blinded, cluster-randomised trial, involving 42 senior hospital physicians (HPs) with their junior HPs and 2100 multimorbid patients aged 60 years or older. Using a randomised minimisation strategy, senior HPs will be assigned to either intervention or control group. Following instructions of the study team, the senior HPs in the intervention group will teach their junior HPs how to integrate a simple medication review tool combined with a defined communication strategy into their ward's discharge procedure. The untrained HPs in the control group will provide data on usual care, and their patients will be discharged following usual local routines. Primary outcome is the time until readmission within 6 months after discharge, and secondary outcomes cover readmission rates, number of emergency and GP visits, classes and numbers of drugs prescribed, proportions of potentially inappropriate medications, and the patients' quality of life after discharge. Additionally, the characteristics of both the HPs as well as the patients will be collected before the intervention. Process evaluation outcomes will be assessed parallel to the ongoing core study using qualitative research methods. DISCUSSION So far, interventions to reduce polypharmacy are still scarce at the crucial interface between HPs and GPs. To our knowledge, this trial is the first to analyse the combination of a brief deprescribing intervention with a standardised communication strategy at hospital discharge and in the early post-discharge period. TRIAL REGISTRATION ISRCTN, ISRCTN18427377 . Registered 11 January 2018.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1748-5908

Publisher:

BioMed Central

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

03 Jan 2019 11:35

Last Modified:

24 Oct 2019 08:56

Publisher DOI:

10.1186/s13012-018-0839-1

PubMed ID:

30591069

Uncontrolled Keywords:

Cluster-randomised controlled trial Deprescribing Hospital discharge Medication review Multimorbidity Patient priorities Polypharmacy Potentially inappropriate medication

BORIS DOI:

10.7892/boris.123139

URI:

https://boris.unibe.ch/id/eprint/123139

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