Abstract
BackgroundDue to ageing of the population the incidence of multimorbidity and polypharmacy is rising. Polypharmacy is a risk factor for medication-related (re)admission and therefore places a significant burden on the healthcare system. The reported incidence of medication-related (re)admissions varies widely due to the lack of a clear definition. Some medications are known to increase the risk for medication-related admission and are therefore published in the triggerlist of the Dutch guideline for Polypharmacy in older patients. Different interventions to support medication optimization have been studied to reduce medication-related (re)admissions. However, the optimal template of medication optimization is still unknown, which contributes to the large heterogeneity of their effect on hospital readmissions. Therefore, we implemented a clinical decision support system (CDSS) to optimize medication lists and investigate whether continuous use of a CDSS reduces the number of hospital readmissions in older patients, who previously have had an unplanned probably medication-related hospitalization.MethodsThe CHECkUP study is a multicentre randomized study in older (≥60 years) patients with an unplanned hospitalization, polypharmacy (≥5 medications) and using at least two medications from the triggerlist, from Zuyderland Medical Centre and Maastricht University Medical Centre+ in the Netherlands. Patients will be randomized. The intervention consists of continuous (weekly) use of a CDSS, which generates a Medication Optimization Profile, which will be sent to the patient’s general practitioner and pharmacist. The control group will receive standard care. The primary outcome is hospital readmission within 1 year after study inclusion. Secondary outcomes are one-year mortality, number of emergency department visits, nursing home admissions, time to hospital readmissions and we will evaluate the quality of life and socio-economic status.DiscussionThis study is expected to add evidence on the knowledge of medication optimization and whether use of a continuous CDSS ameliorates the risk of adverse outcomes in older patients, already at an increased risk of medication-related (re)admission. To our knowledge, this is the first large study, providing one-year follow-up data and reporting not only on quality of care indicators, but also on quality-of-life.Trial registrationThe trial was registered in the Netherlands Trial Register on October 14, 2018, identifier: NL7449 (NTR7691). https://www.trialregister.nl/trial/7449.
Highlights
Due to ageing of the population the incidence of multimorbidity and polypharmacy is rising
Most definitions are based on the assumption thatadmissions are directly related to problems around pharmacotherapy and are defined as (I) drug-related problems, such as drug-drug interactions, inappropriate drug use, sub- and supra-therapeutic dosage, and adverse drug reactions [3, 6]. Another explanation for the wide range in incidence of medication-related hospitaladmissions might be the difference in time-at-risk of adverse outcome, i.e. the time between discharge after the first hospital admission and subsequent readmission in different studies
In view of the considerations above, the aim of this study is to investigate whether the continuous use of a clinical decision support system (CDSS) decreases the number of hospital readmissions in older patients who previously have had an unplanned probably medication-related hospitalization according to the triggerlist from The Dutch multidisciplinary guideline for polypharmacy in older patients [13]
Summary
Due to ageing of the population the incidence of multimorbidity and polypharmacy is rising. It is not surprising that a significant number of these hospital readmissions is directly medication-related and that medication-related hospital (re)admissions occur more frequently in older individuals [3, 4]. Most definitions are based on the assumption that (re)admissions are directly related to problems around pharmacotherapy and are defined as (I) drug-related problems, such as drug-drug interactions, inappropriate drug use, sub- and supra-therapeutic dosage, and adverse drug reactions [3, 6] Another explanation for the wide range in incidence of medication-related hospital (re)admissions might be the difference in time-at-risk of adverse outcome, i.e. the time between discharge after the first hospital admission and subsequent readmission in different studies. Medication-related (re)admissions are probably under recognized, especially in older patients who often tend to have an atypical presentation of illness
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