prioritising patient medication review: hospitals reaching out

Conditions: Medication Review; Polypharmacy; General Practitioners; Interdisciplinary Communication; Clinical Pharmacy

Summary: to examine 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).

lack of medication treatment coordination among especially multi-morbid patient's results in suboptimal medication treatment, adverse effects, increased use of resources, hospital admissions and premature death. further, an aging population is a challenge to healthcare systems worldwide as older adults are vulnerable to non-communicable diseases and multi-morbidity. the age distribution varies across denmark creating demographic inequality with a higher proportion of elderly in several municipalities in southern jutland and on a national level, the population aged 70+ already accounts for more than a third of all hospital days. as the population ages, the concept of frailty becomes increasing in the provision of health care to an ageing population, and the clinical frailty scale (cfs) can be used as a judgement-based frailty tool to evaluate specific domains including comorbidity, function, and cognition to generate a frailty score. in addition, an attempt to detect patients at high risk of medication errors is the medicine risk score (meris) where acutely admitted patients are allocated into low and high risk of potential ades by predefined detection limits. further, these components will be used to determine in addition, an understudied patient group within polypharmacy and pips, are patients with dementia creating inequality among patient groups. the use of polypharmacy and potential inappropriate prescribing are widespread in this patient group, and dementia is well-known to have a negative effect on overall mortality, which demonstrates the need for interventions to improve medication treatment in people with dementia. intervention studies have examined the effects of pharmacist-led medication reviews in different hospital settings with various outcomes, but no exact model for prioritising patient medication review exists. thus, there is a need to identify patients who will benefit most from a medication review in terms of outcomes, such as readmission, emergency department and general practitioner contacts. 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 coordination with the general practitioner (gp), including patients from hospital sønderjylland, university hospital of southern denmark (shs).

Eligibility criteria:
inclusion criteria: * all hospitalized patients who are prescribed at least seven medications specified in the electronic patient journal (epj) at admission exclusion criteria: * terminal patients or patients with a short life expectancy, patients residing in another region, patients who are discharged on the day of inclusion, and finally patients who do not speak danish.

Keywords: multi-morbidity medication review dementia clinical fragility scale hospital to home transition polypharmacy