Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT
Abstract 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 vie...
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| Format: | Article |
| Language: | English |
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BMC
2018-12-01
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| Series: | Implementation Science |
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| Online Access: | http://link.springer.com/article/10.1186/s13012-018-0839-1 |
| _version_ | 1828420618228334592 |
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| author | Thomas Grischott Stefan Zechmann Yael Rachamin Stefan Markun Corinne Chmiel Oliver Senn Thomas Rosemann Nicolas Rodondi Stefan Neuner-Jehle |
| author_facet | Thomas Grischott Stefan Zechmann Yael Rachamin Stefan Markun Corinne Chmiel Oliver Senn Thomas Rosemann Nicolas Rodondi Stefan Neuner-Jehle |
| author_sort | Thomas Grischott |
| collection | DOAJ |
| description | Abstract 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 |
| first_indexed | 2024-12-10T15:15:09Z |
| format | Article |
| id | doaj.art-2ca7aef93795449ab8c6c1d1889662d7 |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-12-10T15:15:09Z |
| publishDate | 2018-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-2ca7aef93795449ab8c6c1d1889662d72022-12-22T01:43:48ZengBMCImplementation Science1748-59082018-12-0113111110.1186/s13012-018-0839-1Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCTThomas Grischott0Stefan Zechmann1Yael Rachamin2Stefan Markun3Corinne Chmiel4Oliver Senn5Thomas Rosemann6Nicolas Rodondi7Stefan Neuner-Jehle8Institute of Primary Care (IHAMZ), University and University Hospital of ZurichInstitute of Primary Care (IHAMZ), University and University Hospital of ZurichInstitute of Primary Care (IHAMZ), University and University Hospital of ZurichInstitute of Primary Care (IHAMZ), University and University Hospital of ZurichInstitute of Primary Care (IHAMZ), University and University Hospital of ZurichInstitute of Primary Care (IHAMZ), University and University Hospital of ZurichInstitute of Primary Care (IHAMZ), University and University Hospital of ZurichInstitute of Primary Health Care (BIHAM), University of BernInstitute of Primary Care (IHAMZ), University and University Hospital of ZurichAbstract 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 2018http://link.springer.com/article/10.1186/s13012-018-0839-1MultimorbidityPolypharmacyHospital dischargeMedication reviewDeprescribingPotentially inappropriate medication |
| spellingShingle | Thomas Grischott Stefan Zechmann Yael Rachamin Stefan Markun Corinne Chmiel Oliver Senn Thomas Rosemann Nicolas Rodondi Stefan Neuner-Jehle Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT Implementation Science Multimorbidity Polypharmacy Hospital discharge Medication review Deprescribing Potentially inappropriate medication |
| title | Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT |
| title_full | Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT |
| title_fullStr | Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT |
| title_full_unstemmed | Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT |
| title_short | Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT |
| title_sort | improving inappropriate medication and information transfer at hospital discharge study protocol for a cluster rct |
| topic | Multimorbidity Polypharmacy Hospital discharge Medication review Deprescribing Potentially inappropriate medication |
| url | http://link.springer.com/article/10.1186/s13012-018-0839-1 |
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