Thomas G H Kempen1,2, Henrik Cam1,3, Amanda Kälvemark1, Karl-Johan Lindner4, Håkan Melhus2, Elisabet I Nielsen3, Johanna Sulku5,6, Ulrika Gillespie1,3. 1. Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden. 2. Department of Medical Sciences, Uppsala University, Uppsala, Sweden. 3. Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden. 4. Pharmacy Department, Region Västmanland, Västerås, Sweden. 5. Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden. 6. Pharmacy Department, Region Gävleborg, Gävle, Sweden.
Abstract
WHAT IS KNOWN AND OBJECTIVE: Drug-related problems (DRPs) are a growing healthcare burden worldwide. In an ongoing cluster-randomized controlled trial in Sweden (MedBridge), comprehensive medication reviews (CMRs) including post-discharge follow-up have been conducted in older hospitalized patients to prevent and solve DRPs. As part of a process evaluation of the MedBridge trial, this study aimed to assess the intervention fidelity and process outcomes of the trial's interventions. METHODS: For intervention delivery, the percentage of patients that received intervention components was calculated per study group. Process outcomes, measured in about one-third of all intervention patients, included the following: the number of identified medication discrepancies, DRPs and recommendations to solve DRPs, correction rate of discrepancies, and implementation rate of recommendations. RESULTS AND DISCUSSION: The MedBridge trial included 2637 patients (mean age: 81 years). The percentage of intervention patients (n = 1745) that received the intended intervention components was 94%-98% during admission, and 40%-81% upon and after discharge. The percentage of control patients (n = 892) that received at least one unintended intervention component was 15%. On average, 1.1 discrepancies and 2.0 DRPs were identified in 652 intervention patients. The correction and implementation rates were 79% and 73%, respectively. Stop medication was the most frequently implemented recommendation (n = 293) and 77% of the patients had at least one corrected discrepancy or implemented recommendation. WHAT IS NEW AND CONCLUSION: The intervention fidelity within the MedBridge trial was high for CMRs during hospital stay and lower for intervention components upon and after discharge. The high prevalence of corrected discrepancies and implemented recommendations may explain potential effects of CMRs in the MedBridge trial.
RCT Entities:
WHAT IS KNOWN AND OBJECTIVE: Drug-related problems (DRPs) are a growing healthcare burden worldwide. In an ongoing cluster-randomized controlled trial in Sweden (MedBridge), comprehensive medication reviews (CMRs) including post-discharge follow-up have been conducted in older hospitalized patients to prevent and solve DRPs. As part of a process evaluation of the MedBridge trial, this study aimed to assess the intervention fidelity and process outcomes of the trial's interventions. METHODS: For intervention delivery, the percentage of patients that received intervention components was calculated per study group. Process outcomes, measured in about one-third of all intervention patients, included the following: the number of identified medication discrepancies, DRPs and recommendations to solve DRPs, correction rate of discrepancies, and implementation rate of recommendations. RESULTS AND DISCUSSION: The MedBridge trial included 2637 patients (mean age: 81 years). The percentage of intervention patients (n = 1745) that received the intended intervention components was 94%-98% during admission, and 40%-81% upon and after discharge. The percentage of control patients (n = 892) that received at least one unintended intervention component was 15%. On average, 1.1 discrepancies and 2.0 DRPs were identified in 652 intervention patients. The correction and implementation rates were 79% and 73%, respectively. Stop medication was the most frequently implemented recommendation (n = 293) and 77% of the patients had at least one corrected discrepancy or implemented recommendation. WHAT IS NEW AND CONCLUSION: The intervention fidelity within the MedBridge trial was high for CMRs during hospital stay and lower for intervention components upon and after discharge. The high prevalence of corrected discrepancies and implemented recommendations may explain potential effects of CMRs in the MedBridge trial.
Authors: Thomas G H Kempen; Maria Bertilsson; Nermin Hadziosmanovic; Karl-Johan Lindner; Håkan Melhus; Elisabet I Nielsen; Johanna Sulku; Ulrika Gillespie Journal: JAMA Netw Open Date: 2021-04-01
Authors: Selma En-Nasery-de Heer; Elien B Uitvlugt; Pierre M Bet; Bart J F van den Bemt; Aida Alai; Patricia M L A van den Bemt; Eleonora L Swart; Fatma Karapinar-Çarkit; Jacqueline G Hugtenburg Journal: J Clin Pharm Ther Date: 2022-03-20 Impact factor: 2.145