Short summary

We want to evaluate the feasibility of cooperation between clinical pharmacists and physicians by conducting a telephone follow-up conversation between the hospital geriatrician, the general practitioner and the clinical pharmacist. During hospital stay the clinical pharmacist and the geriatrician will review older patients' medication and discuss the future treatment with the general practitioner after discharge by telephone or medico-technology.   

The first part of the feasibility study will be a qualitative baseline measure of characteristics of the participants and work flow. The second part will be a pilot randomized controlled study where participants will be allocated to either usual care or medication review and follow up contact. 

Rationale

Between 10-30% of all admissions among older patients are caused by medication-related problems. A meta-analysis from 2002 shows that medication-related admissions are four times higher for older patient than for "non-older". It is assumed that 88% of these admissions could be prevented, which would be of immense importance for both society and the specific patient. There is evidence that comprehensive medication review during hospital stay can prevent medication-related admissions.

Furthermore the transfer from hospital to primary care has been described as critical in regards to mediation treatment. One study has shown that only 1/3 of medication changes during admission are continued post discharge by the general practitioner. In order to achieve a continuous and safe medication treatment in the transfer between sectors, it is necessary with good communication, which however at present is described as inadequate. Medication reconciliation and argumentation for changes are insufficient in the discharge summary, hence it is challenging for the general practitioner to continue and keep an overview of the current treatment.

The aim of this study is to develop and test a model for telephone contact between geriatrician, clinical pharmacist and general practitioner after discharge of the patient. The starting point for this contact will be a systematic medication review performed for older patients during hospital stay by the clinical pharmacist in cooperation with the geriatrician. 

Description of the cohort

The study population will be older patients' over 65 years taking at least 5 different medications and admitted as a geriatric or ortho-geriatric patient. Patients will be included at the hospitals in Odense and Svendborg, Denmark. 

Data and biological material

Data will be analyzed based on information from the National Patient Register, the Danish Cross-sectorial Personal Electronic Medicine profile (FMK) and the electronic patient journal.

Collaborating researchers and departments

Hospital Pharmacy of Funen, Odense University Hospital

• Anton Pottegård, pharmacist, PhD
• Trine Graabæk Hansen, pharmacist, PhD
• Michelle Lyndgaard Nielsen, Clinical pharmacist
• Lene Vestergaard Ravn-Nielsen, Clinical Pharmacist

Geriatric Department, Odense University Hospital

• Jens-Ulrik Rosholm, senior physician, specialist in geriatrics and clin. phar., PhD
• GP in Otterup, Funen, pharmaceutical consultant in the Region of Southern Denmark.
• Palle Mark Christensen, specialist in general medicine and clinical pharmacologist, PhD

Publications associated with the project

Ravn-Nielsen, L.V., Burghle, A., Christensen, P.M. et al. Multidisciplinary telephone conferences about medication therapy after discharge of older inpatients: a feasibility study. Int J Clin Pharm 43, 1381-1393 (2021). https://doi.org/10.1007/s11096-021-01265-8