Effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial

Objective To investigate the effect of pharmacist-led medicines management in multimorbid, hospitalised patients on long-term hospital readmissions and survival.Design Parallel-group, randomised controlled trial.Setting Recruitment from an internal medicine hospital ward in Oslo, Norway. Patients we...

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Autores principales:	Eva Skovlund, Liv Mathiesen, Marianne Lea, Morten Mowé, Espen Molden, Kristin Kvernrød
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2020
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/784a5ec6500944cd957de7a8284a01c1
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spelling	oai:doaj.org-article:784a5ec6500944cd957de7a8284a01c12021-11-20T13:00:06ZEffect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial10.1136/bmjopen-2020-0415582044-6055https://doaj.org/article/784a5ec6500944cd957de7a8284a01c12020-12-01T00:00:00Zhttps://bmjopen.bmj.com/content/10/12/e041558.fullhttps://doaj.org/toc/2044-6055Objective To investigate the effect of pharmacist-led medicines management in multimorbid, hospitalised patients on long-term hospital readmissions and survival.Design Parallel-group, randomised controlled trial.Setting Recruitment from an internal medicine hospital ward in Oslo, Norway. Patients were enrolled consecutively from August 2014 to the predetermined target number of 400 patients. The last participant was enrolled March 2016. Follow-up until 31 December 2017, that is, 21–40 months.Participants Acutely admitted multimorbid patients ≥18 years, using minimum four regular drugs from minimum two therapeutic classes. 399 patients were randomly assigned, 1:1, to the intervention or control group. After excluding 11 patients dying in-hospital and 2 erroneously included, the primary analysis comprised 386 patients (193 in each group) with median age 79 years (range 23–96) and number of diseases 7 (range 2–17).Intervention Intervention patients received pharmacist-led medicines management comprising medicines reconciliation at admission, repeated medicines reviews throughout the stay and medicines reconciliation and tailored information at discharge, according to the integrated medicines management model. Control patients received standard care.Primary and secondary outcome measures The primary endpoint was difference in time to readmission or death within 12 months. Overall survival was a priori the clinically most important secondary endpoint.Results Pharmacist-led medicines management had no significant effect on the primary endpoint time to readmission or death within 12 months (median 116 vs 184 days, HR 0.82, 95% CI 0.64 to 1.04, p=0.106). A statistically significantly increased overall survival was observed during 21–40 months follow-up (HR 0.66, 95% CI 0.48 to 0.90, p=0.008).Conclusions Pharmacist-led medicines management had no statistically significant effect on time until readmission or death. A statistically significant increased overall survival was seen. Further studies should be conducted to investigate the effect of such an intervention on a larger scale.Trial registration number NCT02336113.Eva SkovlundLiv MathiesenMarianne LeaMorten MowéEspen MoldenKristin KvernrødBMJ Publishing GrouparticleMedicineRENBMJ Open, Vol 10, Iss 12 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Eva Skovlund Liv Mathiesen Marianne Lea Morten Mowé Espen Molden Kristin Kvernrød Effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial
description	Objective To investigate the effect of pharmacist-led medicines management in multimorbid, hospitalised patients on long-term hospital readmissions and survival.Design Parallel-group, randomised controlled trial.Setting Recruitment from an internal medicine hospital ward in Oslo, Norway. Patients were enrolled consecutively from August 2014 to the predetermined target number of 400 patients. The last participant was enrolled March 2016. Follow-up until 31 December 2017, that is, 21–40 months.Participants Acutely admitted multimorbid patients ≥18 years, using minimum four regular drugs from minimum two therapeutic classes. 399 patients were randomly assigned, 1:1, to the intervention or control group. After excluding 11 patients dying in-hospital and 2 erroneously included, the primary analysis comprised 386 patients (193 in each group) with median age 79 years (range 23–96) and number of diseases 7 (range 2–17).Intervention Intervention patients received pharmacist-led medicines management comprising medicines reconciliation at admission, repeated medicines reviews throughout the stay and medicines reconciliation and tailored information at discharge, according to the integrated medicines management model. Control patients received standard care.Primary and secondary outcome measures The primary endpoint was difference in time to readmission or death within 12 months. Overall survival was a priori the clinically most important secondary endpoint.Results Pharmacist-led medicines management had no significant effect on the primary endpoint time to readmission or death within 12 months (median 116 vs 184 days, HR 0.82, 95% CI 0.64 to 1.04, p=0.106). A statistically significantly increased overall survival was observed during 21–40 months follow-up (HR 0.66, 95% CI 0.48 to 0.90, p=0.008).Conclusions Pharmacist-led medicines management had no statistically significant effect on time until readmission or death. A statistically significant increased overall survival was seen. Further studies should be conducted to investigate the effect of such an intervention on a larger scale.Trial registration number NCT02336113.
format	article
author	Eva Skovlund Liv Mathiesen Marianne Lea Morten Mowé Espen Molden Kristin Kvernrød
author_facet	Eva Skovlund Liv Mathiesen Marianne Lea Morten Mowé Espen Molden Kristin Kvernrød
author_sort	Eva Skovlund
title	Effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial
title_short	Effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial
title_full	Effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial
title_fullStr	Effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial
title_full_unstemmed	Effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial
title_sort	effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial
publisher	BMJ Publishing Group
publishDate	2020
url	https://doaj.org/article/784a5ec6500944cd957de7a8284a01c1
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Effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial

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