This study is being done to find out if a multi-faceted intervention designed to optimize medication in hospitalized older people with multiple chronic medical conditions exposed to multiple medications can reduce unplanned hospital readmission and emergency department attendance compared to current usual medication management. The study intervention aims to minimize potentially inappropriate medications in a structured way and involves follow up with patients and GPs. Patients will be allocated equally to (i) standard medication management (control arm) or (ii) trained physician-delivered intervention or (iii) clinical pharmacist-delivered intervention.
Who can participate
Age range70 Years
SexALL
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Inclusion criteria
✓. Age ≥ 70years
✓. 3 or more chronic conditions.
✓. ≥ 5 daily medications pre-admission, all medications taken for at least 4 weeks continuously.
✓. Can speak and understand English (in the two Irish medical centres), and Dutch or French in Ghent University Hospital (Ghent is predominantly Dutch-speaking).
✓. Can give informed consent or give witnessed verbal consent or have a suitable proxy who can give informed assent on the patient's behalf.
✓. Agrees to follow-up contact post-discharge up to 180 days post-randomization.
✓. Agrees to primary researcher contacting the GP and community pharmacist post-discharge.
Exclusion criteria
✕. Terminal illness.
✕. Severe dementia and clearly unable to understand the purpose of the trial or give consent to participation.
What they're measuring
1
Unscheduled readmission to hospital.
Timeframe: At day 30 post-discharge.
2
Emergency Department attendance.
Timeframe: At day 30 post-discharge.
3
Composite endpoint 1
Timeframe: At day 30 post-discharge.
4
Unscheduled readmission to hospital.
Timeframe: At between days 90 and 180 post-discharge.
5
Emergency Department attendance.
Timeframe: At between days 90 and 180 post-discharge.
6
Composite endpoint 2
Timeframe: At between days 90 and 180 post-discharge.