Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (IMMENSE study): study protocol for a randomised controlled trial

Abstract

IntroductionDrug-related problems (DRPs) are common in the elderly, leading to suboptimal therapy, hospitalisations and increased mortality. The integrated medicines management (IMM) model is a multifactorial interdisciplinary methodology aiming to optimise individual medication therapy throughout the hospital stay. IMM has been shown to reduce readmissions and drug-related hospital readmissions. Using the IMM model as a template, we have designed an intervention aiming both to improve medication safety in hospitals, and communication across the secondary and primary care interface. This paper presents the study protocol to explore the effects of the intervention with regard to healthcare use, health-related quality of life (HRQoL) and medication appropriateness in elderly patients.Methods and analysisA total of 500 patients aged ≥70 years will be included and randomised to control (standard care) or intervention group (1:1). The intervention comprises five steps mainly performed by pharmacists: (1) medication reconciliation at admission, (2) medication review during hospital stay, (3) patient counselling about the use of medicines, (4) a comprehensible and patient-friendly medication list with explanations in discharge summary and (5) postdischarge phone calls to the primary care level. The primary outcome is the difference between intervention and control patients in the rate of emergency medical visits (acute readmissions and visits to emergency department) 12 months after discharge. Secondary outcomes include length of index hospital stay, time to first readmission, mortality, hip fractures, strokes, medication changes, HRQoL and medication appropriateness. Patient inclusion started in September 2016.Ethics and disseminationThe trial was approved by the Norwegian Centre for Research Data and the Norwegian Data Protection Authority. We aim to publish the results in international peer-reviewed open access journals, at national and international conferences, and as part of two PhD theses.Trial registration number NCT02816086.

Non-Pharmacological Interventions towards Preventing the Triad Osteoporosis-Falls Risk-Hip Fracture, in Population Older than 65. Scoping Review

“…o Drugs at risk of postural hypotension: diuretics, antihypertensives [ 61 , 62 , 63 , 64 ]. Medication that can cause postural hypotension, foot problems and the use of appropriate footwear should also be evaluated [ 43 , 65 , 66 ].…”

“…Special emphasis should be placed on medication adjustment and control of underlying diseases as they increase the presence of osteoporosis and falls, causing an increased risk of hip fracture [61][62][63][64]. These are as psychoactive drugs (hypnotics, anxiolytics, antidepressants, antiepileptics, benzodiazepines, opioids, etc.…”

“…These are as psychoactive drugs (hypnotics, anxiolytics, antidepressants, antiepileptics, benzodiazepines, opioids, etc. ), those that decrease bone mass density (glucocorticoids, l-thyroxine, heparin, antiepileptics, neuroleptics, chemotherapy, the Gonadotropin-releasing hormone (GnR), aromatase inhibitors, methotrexate, cyclosporine A, vitamin A, and synthetic retinoids, lithium, and antidepressants), and those that pose a risk of postural hypotension (diuretics, antihypertensives) [ 43 , 54 , 59 , 60 , 61 , 62 , 63 , 64 , 67 ].…”

“…Drugs responsible for falls increase in older people: o Psychoactives: hypnotics, anxiolytics, antidepressants, antiepileptics, benzodiazepines, opioids, etc. [59,60] o Drugs at risk of postural hypotension: diuretics, antihypertensives [61][62][63][64]. Medication that can cause postural hypotension, foot problems and the use of appropriate footwear should also be evaluated [43,65,66].…”

Medication Management Models for Polymedicated Home-Dwelling Older Adults With Multiple Chronic Conditions: Protocol of a Systematic Review

“…However, a substantial proportion of older adults have multiple chronic diseases requiring numerous treatment components and complex medication regimes [6]. Increasingly complex medication regimes, combined with frailty, reduced cognitive function, and changing pharmacokinetics and pharmacodynamics, increase the risk of adverse drug events and other medication-related problems (MRPs) in this population [7]. An MRP is “an event or circumstance involving medication therapy that actually or potentially interferes with desired health outcomes” [8].…”