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Medication Reviews Bridging Healthcare (MedBridge): Study protocol for a pragmatic cluster-randomised crossover trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Pharmacy Department, Västmanland County Council, Västerås, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Reg Gavleborg, Dept Dev, Gavle, Sweden.
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2017 (English)In: Contemporary Clinical Trials, ISSN 1551-7144, E-ISSN 1559-2030, Vol. 61, p. 126-132, article id S1551-7144(16)30455-4Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
2017. Vol. 61, p. 126-132, article id S1551-7144(16)30455-4
Keyword [en]
Cluster analysis, Crossover design, Inappropriate prescribing, Integrated health care systems, Medication review, Pragmatic clinical trial
National Category
Pharmacology and Toxicology
Identifiers
URN: urn:nbn:se:uu:diva-343810DOI: 10.1016/j.cct.2017.07.019ISI: 000411539600018PubMedID: 28739539OAI: oai:DiVA.org:uu-343810DiVA, id: diva2:1186777
Available from: 2018-03-01 Created: 2018-03-01 Last updated: 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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Clinical pharmacogenomics and osteoporosisUCR-Uppsala Clinical Research CenterCentre for Research and Development, GävleborgDepartment of Pharmaceutical Biosciences
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Contemporary Clinical Trials
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