The effect of a trAnSitional Pharmacist Intervention in geRiatric inpatients on hospital visits after dischargE (ASPIRE): Protocol for a randomized controlled trial

Hias, Julie; Hellemans, Laura; Laenen, Annouschka; Walgraeve, Karolien; Liesenborghs, Astrid; Sabina, De Geest; Luyten, Jeroen; Isabel, Spriet; Flamaing, Johan; Linden, Lorenz Van der; Tournoy, Jos

doi:10.1016/j.cct.2022.106853

Cited by 5 publications

(2 citation statements)

References 31 publications

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“…Furthermore, the current study was only limited to one month follow-up. Importantly, this deprescribing intervention has now been incorporated in the ASPIRE intervention, where it will be part of a broader approach to improve medication use and clinical outcome [ 34 ]. ASPIRE concerns an ongoing RCT on our acute geriatric wards where the impact of a multifaceted pharmacist intervention will be compared to usual geriatric care on the time to a first unplanned hospital revisit with a follow-up of six months after discharge.…”

Section: Discussionmentioning

confidence: 99%

The impact of a pharmacist intervention on post-discharge hypnotic drug discontinuation in geriatric inpatients: a before-after study

et al. 2023

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Background Chronic use of hypnotic agents is prevalent in older adults, who as a result are at increased risk for certain adverse events, such as day-time drowsiness and falls. Multiple strategies to discontinue hypnotics have been tested in geriatric patients, but evidence remains scarce. Hence, we aimed to investigate a multicomponent intervention to reduce hypnotic drug use in geriatric inpatients. Methods A before-after study was performed on the acute geriatric wards of a teaching hospital. The before group (= control group) received usual care, while intervention patients (= intervention group) were exposed to a pharmacist-led deprescribing intervention, comprising education of health care personnel, access to standardized discontinuation regimens, patient education and support of transitional care. The primary outcome was hypnotic drug discontinuation at one month after discharge. Secondary outcomes among others were sleep quality and hypnotic use at one and two weeks after enrolment and at discharge. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) upon inclusion, two weeks after enrolment and one month after discharge. Determinants for the primary outcome were identified using regression analysis. Results A total of 173 patients were enrolled, with 70.5% of patients taking benzodiazepines. Average age was 85 years (interquartile range 81–88.5) and 28.3% were male. A higher discontinuation rate at one month after discharge was observed in favour of the intervention (37.7% vs. 21.9%, p = 0.02281). No difference in sleep quality was found between both groups (p = 0.719). The average sleep quality was 8.74 (95% confidence interval (CI): 7.98–9.49) and 8.57 (95% CI: 7.75–9.39) in the control and intervention groups respectively. Determinants for discontinuation at one month were: the intervention (odds ratio (OR) 2.36, 95% CI: 1.14–4.99), fall on admission (OR 2.05; 95% CI: 0.95–4.43), use of a z-drug (OR 0.54, 95% CI: 0.23–1.22), PSQI score on admission (OR 1.08, 95% CI: 0.97–1.19) and discontinuation prior to discharge (OR 4.71, 95% CI: 2.26–10.17). Conclusions A pharmacist-led intervention in geriatric inpatients was associated with a reduction of hypnotic drug use one month after discharge, without any loss in sleep quality. Trial registration ClinicalTrials.gov Identifier: NCT05521971 (retrospectively registered on 29th of August 2022).

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Section: Discussionmentioning

confidence: 99%

The impact of a pharmacist intervention on post-discharge hypnotic drug discontinuation in geriatric inpatients: a before-after study

et al. 2023

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“…Furthermore, the current study was only limited to one month follow-up. The deprescribing intervention has now been incorporated in the ASPIRE intervention, where it will be part of a broader approach to improve medication use and clinical outcome [34]. ASPIRE concerns an ongoing RCT on our acute geriatric wards where the impact of a multifaceted pharmacist intervention will be compared to usual geriatric care on the time to a rst unplanned hospital revisit with a follow-up up to six months after discharge.…”

Section: Discussionmentioning

confidence: 99%

The impact of a pharmacist intervention on post-discharge hypnotic drug discontinuation in geriatric inpatients: a before-after study

Linden

Hias

Liesenborghs

et al. 2022

Preprint

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Background Chronic use of hypnotic agents is prevalent in older adults, who as a result are at increased risk for certain adverse events, such as day-time drowsiness and falls. Multiple strategies to discontinue hypnotics have been tested in geriatric patients, but evidence remains scarce. Hence, we aimed to investigate a multicomponent intervention to reduce hypnotic drug use in geriatric inpatients. Methods A before-after study was performed on the acute geriatric wards of a teaching hospital. The before cohort received usual care while intervention patients were exposed to a pharmacist-led deprescribing intervention, comprising education of health care personnel, access to standardized discontinuation regimens, patient education and support of transitional care. The primary outcome was hypnotic drug discontinuation at one month after discharge. Secondary outcomes among others were sleep quality and hypnotic use at one and two weeks after enrolment and at discharge. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) upon inclusion, two weeks after enrolment and one month after discharge. Determinants for the primary outcome were identified using regression analysis. Results A total of 173 patients were enrolled, with 70.5% of patients taking benzodiazepines. Average age was 85 years (interquartile range 81-88.5) and 28.3% were male. A higher discontinuation rate at one month after discharge was observed in favour of the intervention cohort (37.7% vs. 21.9%, p = 0.02281). No difference in sleep quality was found between the two cohorts (p = 0.719). The average sleep quality was 8.74 (95% confidence interval (CI): 7.98–9.49) and 8.57 (95% CI: 7.75–9.39) in the before and after cohorts respectively. Determinants for discontinuation at one month were: the intervention (odds ratio (OR) 2.36, 95% CI: 1.14–4.99), fall on admission (OR 2.05; 95% CI: 0.95–4.43), use of a z-drug (OR 0.54, 95% CI: 0.23–1.22), PSQI score on admission (OR 1.08, 95% CI: 0.97–1.19) and discontinuation prior to discharge (OR 4.71, 95% CI: 2.26–10.17). Conclusions A pharmacist-led intervention in geriatric inpatients was associated with a reduction of hypnotic drug use one month after discharge, without any loss in sleep quality. Trial registration ClinicalTrials.gov Identifier: NCT05521971 (retrospectively registered on 29th of August 2022)

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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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The effect of a trAnSitional Pharmacist Intervention in geRiatric inpatients on hospital visits after dischargE (ASPIRE): Protocol for a randomized controlled trial

Cited by 5 publications

References 31 publications

The impact of a pharmacist intervention on post-discharge hypnotic drug discontinuation in geriatric inpatients: a before-after study

The impact of a pharmacist intervention on post-discharge hypnotic drug discontinuation in geriatric inpatients: a before-after study

The impact of a pharmacist intervention on post-discharge hypnotic drug discontinuation in geriatric inpatients: a before-after study

Medication review in hospitalised patients to reduce morbidity and mortality

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