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Medication Reviews Bridging Healthcare (MedBridge): Study protocol for a pragmatic cluster-randomised crossover trial
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
Pharmacy Department, Västmanland County Council, Västerås, Sweden.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Reg Gavleborg, Dept Dev, Gavle, Sweden.
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2017 (Engelska)Ingår i: Contemporary Clinical Trials, ISSN 1551-7144, E-ISSN 1559-2030, Vol. 61, s. 126-132, artikel-id S1551-7144(16)30455-4Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: Mismanaged prescribing and use of medication among elderly puts major pressure on current healthcare systems. Performing a medication review, a structured critical examination of a patient's medications, during hospital stay with active follow-up into primary care could optimise treatment benefit and minimise harm. However, a lack of high quality evidence inhibits widespread implementation. This manuscript describes the rationale and design of a pragmatic cluster-randomised, crossover trial to fulfil this need for evidence.

AIM: To study the effects of hospital-initiated comprehensive medication reviews, including active follow-up, on elderly patients' healthcare utilisation compared to 1) usual care and 2) solely hospital based reviews.

DESIGN: Multicentre, three-treatment, replicated, cluster-randomised, crossover trial.

SETTING: 8 wards with a multidisciplinary team within 4 hospitals in 3 Swedish counties.

PARTICIPANTS: Patients aged 65years or older, admitted to one of the study wards.

EXCLUSION CRITERIA: Palliative stage; residing in other than the hospital's county; medication review within the last 30days; one-day admission.

INTERVENTIONS: 1, comprehensive medication review during hospital stay; 2, same as 1 with the addition of active follow-up into primary care; 3, usual care.

PRIMARY OUTCOME MEASURE: Incidence of unplanned hospital visits during a 12-month follow-up period.

DATA COLLECTION AND ANALYSES: Extraction and collection from the counties' medical record system into a GCP compliant electronic data capture system. Intention-to-treat-analyses using hierarchical models.

RELEVANCE: This study has a high potential to show a reduction in elderly patients' morbidity, contributing to more sustainable healthcare in the long run.

Ort, förlag, år, upplaga, sidor
2017. Vol. 61, s. 126-132, artikel-id S1551-7144(16)30455-4
Nyckelord [en]
Cluster analysis, Crossover design, Inappropriate prescribing, Integrated health care systems, Medication review, Pragmatic clinical trial
Nationell ämneskategori
Farmakologi och toxikologi
Identifikatorer
URN: urn:nbn:se:uu:diva-343810DOI: 10.1016/j.cct.2017.07.019ISI: 000411539600018PubMedID: 28739539OAI: oai:DiVA.org:uu-343810DiVA, id: diva2:1186777
Tillgänglig från: 2018-03-01 Skapad: 2018-03-01 Senast uppdaterad: 2018-05-16

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Kempen, ThomasBertilsson, MariaSulku, JohannaNielsen, Elisabet I.Melhus, HåkanGillespie, Ulrika

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Kempen, ThomasBertilsson, MariaSulku, JohannaNielsen, Elisabet I.Melhus, HåkanGillespie, Ulrika
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Klinisk farmakogenomik och osteoporosUppsala kliniska forskningscentrum (UCR)Centrum för klinisk forskning, GävleborgInstitutionen för farmaceutisk biovetenskap
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