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Eur J Clin Pharmacol. 2017 Jul;73(7):827-835. doi: 10.1007/s00228-017-2249-8. Epub 2017 Apr 8.

Pharmacist participation in hospital ward teams and hospital readmission rates among people with dementia: a randomized controlled trial.

Author information

1
Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 85, Umeå, Sweden. maria.gustafsson@umu.se.
2
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden. maria.gustafsson@umu.se.
3
Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 85, Umeå, Sweden.
4
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.

Abstract

PURPOSE:

To assess whether comprehensive medication reviews conducted by clinical pharmacists as part of a healthcare team reduce drug-related hospital readmission rates among people with dementia or cognitive impairment.

METHODS:

This randomized controlled trial was carried out between January 9, 2012, and December 2, 2014. Patients aged ≥65 years with dementia or cognitive impairment admitted to three wards at two hospitals located in Northern Sweden were included.

RESULTS:

Of the 473 deemed eligible for participation, 230 were randomized to intervention and 230 to control group by block randomization. The primary outcome, risk of drug-related hospital readmissions, was assessed at 180 days of follow-up by intention-to-treat analysis. During the 180 days of follow-up, 18.9% (40/212) of patients in the intervention group and 23.0% (50/217) of those in the control group were readmitted for drug-related reasons (HR = 0.80, 95% CI = 0.53-1.21, p = 0.28, univariable Cox regression). Heart failure was significantly more common in the intervention group. After adjustment for heart failure as a potential confounder and an interaction term, multiple Cox regression analysis indicated that pharmacist participation significantly reduced the risk of drug-related readmissions (HR = 0.49, 95% CI = 0.27-0.90, p = 0.02). A post-hoc analysis showed a significantly reduced risk of 30-day readmissions due to drug-related problems in the total sample (without adjustment for heart failure).

CONCLUSION:

Participation of clinical pharmacists in healthcare team conducting comprehensive medication reviews did not significantly reduce the risk of drug-related readmissions in patients with dementia or cognitive impairment; however, post-hoc and subgroup analyses indicated significant effects favoring the intervention. More research is needed.

TRIAL REGISTRATION:

Clinical trials NCT01504672.

KEYWORDS:

Clinical pharmacists; Dementia; Drug-related readmissions; Medication reviews; Old people

PMID:
28391409
PMCID:
PMC5486919
DOI:
10.1007/s00228-017-2249-8
[Indexed for MEDLINE]
Free PMC Article

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