Abstract
PurposeIn the Trondheim Hip Fracture Trial, 397 home-dwelling patients with hip fractures were randomised to comprehensive geriatric care (CGC) in a geriatric ward or traditional orthopaedic care (OC). Patients in the CGC group had significantly better mobility and function 4 months after discharge. This study explores group differences in drug prescribing and possible associations with the outcomes in the main study.MethodsDrugs prescribed at admission and discharge were registered from hospital records. Mobility, function, fear of falling and quality of life were assessed using specific rating scales. Linear regression was used to analyse association between drug changes and outcomes at 4 months.ResultsThe mean age was 83 years, and 74% were females. The mean number (± SD) of drugs in the CGC and OC groups was 3.8 (2.8) and 3.9 (2.8) at inclusion and 7.1 (2.8) and 6.2 (3.0) at discharge, respectively (p = 0.003). The total number of withdrawals was 209 and 82 in the CGC and OC groups, respectively (p < 0.0001), and the number of starts was 844 and 526, respectively (p < 0.0001). A significant negative association was found between the number of drug changes during the hospital stay and mobility and function 4 months later in both groups. However, this association disappeared when adjusting for baseline function and comorbidities.ConclusionThese secondary analyses suggest that there are significant differences in the pharmacological treatment between geriatric and orthopaedic wards, but these differences could not explain the beneficial effect of CGC in the Trondheim Hip Fracture Trial.
Highlights
Patients with hip fractures are often frail, of advanced age and with extensive comorbidity
The present study is based on post hoc analyses; the specific aim was to investigate how drug treatment provided as part of the comprehensive geriatric care (CGC) differed from that offered in traditional orthopaedic care and whether differences in drug prescribing can explain the beneficial impact of CGC on mobility, function, quality of life and fear of falling 4 months after discharge from hospital, as shown in our primary publication [10]
A total of 1077 patients were screened for eligibility, of whom 397 were randomly assigned to receive either CGC (n = 198) or orthopaedic care (OC) (n = 199)
Summary
Drugs prescribed at admission and discharge were registered from hospital records. Mobility, function, fear of Marianne Heltne and Ingvild Saltvedt are joint first authors. Electronic supplementary material The online version of this article (doi:10.1007/s00228-017-2263-x) contains supplementary material, which is available to authorized users
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