Short summary

The aim of this project is to examine the effect of a cross-sectoral medication review between a clinical pharmacist and a medical specialist in coordina-tion with the General Practitioner. The goals include: • To develop screening criteria to select patients with most benefits from receiving a medication re-view in the emergency and outpatient setting, respectively • to optimize the patients' medical treatment • to prevent readmissions to the emergency ward

Rationale

General practicioners (GPs) play a crucial role in the appropriate prescription of medications and medicines optimization among older adults. Multi-morbid patients are often in contact with several specialists as well as their GP, and prescribing is one of the most complex and important actions of multi-morbidity management. The individual specialists focus on their own area of expertise; for example, specialists initiate many of the medications taken by patients with multi-morbidity, but the responsibility for repeated prescribing of these medications lies with primary care. Thus, coordination of the individual patient course between clinicians as well as across sectors is essential for optimal patient care. To ensure a patient-safe sharing of information, the hospital discharge summary plays an important role, An evaluation of the usability of the discharge summaries implies that there is room for optimizing the discharge summary from hospitals to GPs. Thus, in this study, relevant medical discharge summaries between hospital pharmacists and GPs will be explored in order to optimize current GP experiences with its relevance and usability in practice. The overall aim of this project is to prevent inequalities in research among multi-morbid patients admitted to hospitals, and to create coherent patient care procedures in the medication process across health sectors and healthcare professionals. This will be achieved through examining the effect of a cross-sectoral medication review intervention to admitted multi-morbid, polypharmacy patients aged 65+ at SHS in two settings; an acute admission unit (typical admission time < 48 hours) and a medical outpatient setting (patients routinely visits for follow-up, diagnosis or treatment, but do require a bed or overnight care). Further, the project will involve a collaboration between clinical pharmacists, medical specialists, and GPs. The goals include: • To develop screening criteria to select patients who will benefit the most of receiving a med-ication review in the acute admission unit and outpatient setting, respectively • to ensure patient safety by optimizing the patients' medical treatment • to improve the delivery of pharmacist interventions to GPs through discharge summaries • to optimize the patients' medical treatment • to prevent readmissions to the emergency ward • to address health inequality by inviting all eligible patients including patients suffering from dementia to participate We strive to achieve the goals by conducting four sub-studies: • Register study describing the target population according to diagnoses, medication use, so-ciodemographic characteristics • Exploratory study examining the optimal delivery of pharmacist interventions from medica-tion reviews through discharge summaries to GPs • Randomised Controlled Trial (RCT) at the acute admission unit at SHS • RCT at the outpatient internal medicine setting at SHS

Description of the cohort

Multi-morbid patients in the age 65+ with multiple medication use (at least seven medications) and admitted to Hospital Sønderjylland, University Hospital of Southern Denmark (SHS), at the acute admission unit (FAM) and at the Outpatient Care Center at the Internal Medicine ward.

Data and biological material

In this study we use demographic and medical data (i.e. age, sex, medical history, admission type, reason for admission, medicine risk score etc.) from a combination of questionnaire data, patient journal and from regional databases.

Collaborating researchers and departments

The Research Unit of General Practice, University of Southern Denmark

• Jens Søndergaard

The Outpatient Care Center, Department of Internal Medicine, Hospital Sønderjylland

• Frans Brandt Kristensen

Deparment of Internal Medicine, Hospital Sønderjylland

• Morten Gammelgaard

The Emergency Department, Hospital Sønderjylland

• Eva Holtved