Intervention fidelity and process outcomes of the IMMENSE study, a pharmacist‐led interdisciplinary intervention to improve medication safety in older hospitalized patients

Johansen, Jeanette Schultz; Halvorsen, Kjell H.; Havnes, Kjerstin; Wetting, Hilde Ljones; Svendsen, Kristian; García, Beate Hennie

doi:10.1111/jcpt.13581

Cited by 7 publications

(8 citation statements)

References 37 publications

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“…1). See Johansen et al for further details on intervention fidelity and process outcomes (MRPs and medication discrepancies) of the PP population [29].…”

Section: Resultsmentioning

confidence: 99%

“…In addition, several MRPs (median 4, IQR 2-6) and medication discrepancies (median 1, IQR 0-3) were identified among intervention patients [29]. In total, 67% of MRPs were solved in the interdisciplinary team in the hospital as recommended by the pharmacist, and 23% communicated to primary care [29], suggesting a high agreement within the interdisciplinary hospital team and a realistic potential for optimized medication regimes. Despite these positive figures, health care use was not significantly affected.…”

Section: Characteristicsmentioning

confidence: 99%

“…Baseline data collected: age, gender, marital status, level of education, type and amount of help from home care services, delivery of multi dosage dispensed medications, medical diagnosis/medical history, and medication use at the time of hospital admission. Data was registered in a Microsoft ® Access database which has been the basis for previously reported data on intervention fidelity and process data on identified MRPs [29].…”

Section: Data Collection and Outcome Assessmentmentioning

confidence: 99%

“…A second possible explanation for the lack of effect may be a failure to implement the intervention properly, which we do not fully believe is the case. The intervention fidelity of the IMMENSE intervention was generally good, as the first two steps of the intervention was delivered to all but three participants, and the remaining steps to more than 70% of the participants where these were relevant [29]. The steps relating to discharge and communication with primary care were the most challenging to implement, requiring time from collaboration health care personnel.…”

Section: Characteristicsmentioning

confidence: 99%

“…We had aimed at promoting sustainable effects of the intervention by including the fifth step of the IMMENSE intervention, enabling the GPs to improve follow-up on medication optimization. How GPs acted upon the recommendations is however unknown [29]. In future studies, interventions in hospitals should consider even closer collaboration with primary care, including follow-up at home or in primary care centers.…”

Section: Characteristicsmentioning

confidence: 99%

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Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study) – a randomized controlled trial

Johansen

Halvorsen

Svendsen

et al. 2022

BMC Health Serv Res

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Background Suboptimal medication use contributes to a substantial proportion of hospitalizations and emergency department visits in older adults. We designed a clinical pharmacist intervention to optimize medication therapy in older hospitalized patients. Based on the integrated medicine management (IMM) model, the 5-step IMMENSE intervention comprise medication reconciliation, medication review, reconciled medication list upon discharge, patient counselling, and post discharge communication with primary care. The objective of this study was to evaluate the effects of the intervention on healthcare use and mortality. Methods A non-blinded parallel group randomized controlled trial was conducted in two internal medicine wards at the University Hospital of North Norway. Acutely admitted patients ≥ 70 years were randomized 1:1 to intervention or standard care (control). The primary outcome was the rate of emergency medical visits (readmissions and emergency department visits) 12 months after discharge. Results Of the 1510 patients assessed for eligibility, 662 patients were asked to participate, and 516 were enrolled. After withdrawal of consent and deaths in hospital, the modified intention-to-treat population comprised 480 patients with a mean age of 83.1 years (SD: 6.3); 244 intervention patients and 236 control patients. The number of emergency medical visits in the intervention and control group was 497 and 499, respectively, and no statistically significant difference was observed in rate of the primary outcome between the groups [adjusted incidence rate ratio of 1.02 (95% CI: 0.82–1.27)]. No statistically significant differences between groups were observed for any of the secondary outcomes, neither in subgroups, nor for the per-protocol population. Conclusions We did not observe any statistical significant effects of the IMMENSE intervention on the rate of emergency medical visits or any other secondary outcomes after 12 months in hospitalized older adults included in this study. Trial registration The trial was registered in clinicaltrials.gov on 28/06/2016, before enrolment started (NCT02816086).

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“…1). See Johansen et al for further details on intervention fidelity and process outcomes (MRPs and medication discrepancies) of the PP population [29].…”

Section: Resultsmentioning

confidence: 99%

Section: Characteristicsmentioning

confidence: 99%

Section: Data Collection and Outcome Assessmentmentioning

confidence: 99%

Section: Characteristicsmentioning

confidence: 99%

Section: Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study) – a randomized controlled trial

Johansen

Halvorsen

Svendsen

et al. 2022

BMC Health Serv Res

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Medication review in hospitalised patients to reduce morbidity and mortality

Bülow

Clausen

Lundh

et al. 2023

Cochrane Database of Systematic Reviews

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Health-related quality of life among older adults following acute hospitalization: longitudinal analysis of a randomized controlled trial

Robinson,

Gyllensten,

Granas

et al. 2024

Qual Life Res

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Purpose To describe the longitudinal change of health-related quality of life (HRQoL) over 12 months from acute hospitalization in older adults ≥ 70 years (IMMENSE study), and associated factors, to investigate how a medication optimization intervention influenced this change. Methods The EQ-5D-3L was used at discharge and 1, 6 and 12 months after discharge during a randomized controlled trial including 285 participants. Multilevel logistic (EQ-5D-3L dimensions) and mixed model regression (EQ-5D-3L index scores, EQ-VAS) were used to explore the longitudinal change with/without the intervention, and associations with medications, comorbidities, and socioeconomic variables. Subgroup analyses were performed for non-long and long stayers with hospitalizations < or ≥ 14 days. Results EQ-5D-3L index scores significantly declined after 12 months (β −0.06 [95% confidence interval (CI:) −0.10–−0.02], p = 0.003). Non-long stayers showed significant improvement 1 month from discharge (β 0.05 [0.00–0.09], p = 0.040). The number of medications and receiving home-care services were the main factors associated with reduced HRQoL. Being home-dwelling was the main factor associated with higher HRQoL. Non-long stayers of the intervention group reported significantly higher EQ-VAS than the control group (β 4.02 [0.11–7.93], p = 0.044). Conclusion We observed no significant difference in the longitudinal change in HRQoL between the two IMMENSE study groups over 12 months after hospitalization. However, the non-long stayer subgroup analysis indicates that the intervention may have had a long-term effect on HRQoL in some of intervention patients. The number of medications and the ability to live and care for oneself should be taken into consideration when planning future patient care and health-care services. Trial registration The trial was registered in clinicaltrials.gov on 28/06/2016 before enrolment started (NCT02816086).

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Intervention fidelity and process outcomes of the IMMENSE study, a pharmacist‐led interdisciplinary intervention to improve medication safety in older hospitalized patients

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 7 publications

References 37 publications

Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study) – a randomized controlled trial

Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study) – a randomized controlled trial

Medication review in hospitalised patients to reduce morbidity and mortality

Health-related quality of life among older adults following acute hospitalization: longitudinal analysis of a randomized controlled trial

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