Therapeutic Conflicts and Multimorbidity

Study Overview
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Brief Summary
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Clinical practice guidelines do not take into account multimorbidity and various potential therapeutic conflicts. Identifying and quantifying therapeutic conflicts is crucial in multimorbid patients having more than two acute or chronic diseases. Guidance should be available for frequent encountered situations, e.g. gastrointestinal bleeding or exacerbation of diabetes mellitus.

Detailed Description
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The study investigates multimorbidity in view of the occurrence of two different therapeutic conflicts or dilemma situations, respectively. The first concerns patients with diagnosis of gastrointestinal bleeding and prescription of anticoagulants or/and antiplatelet drugs (e.g., warfarin, clopidogrel and acetylsalicylic acid) as a risk factor for bleeding events. The second concerns patients with diagnosis of exacerbated diabetes mellitus and prescription of corticosteroids as a risk factor for worsening of blood glucose.

Official Title
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Therapeutic Conflicts in Hospitalized Patients: Retrospective Analyses of Patients With GI Bleeding or Exacerbated Diabetes and Impact of Multimorbidity.

Conditions
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Gastrointestinal Hemorrhage, Diabetes Complications, Multimorbidity

Intervention / Treatment
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* Other: drug-drug or drug-disease interaction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Inpatients at the University Hospital Zurich, USZ Male and female patients, aged 18 years or older Fulfilling the criteria for Use Case A or B (i.e. patients with gastrointestinal bleeding and anticoagulants or antiplatelet drugs, Use Case A or patients with diabetes mellitus and/or systemic corticosteroids, Use Case B) Exclusion Criteria: If potential participants have a statement in the electronic medical record or elsewhere to refuse study participation, this represents exclusion criteria.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Multimorbid patients<br> | Other: drug-drug or drug-disease interaction<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patients with gastrointestinal bleeding and anticoagulants or antiplatelet drugs | Do anticoagulants or antiplatelet drugs increase the risk of repeated bleeding in patients with gastrointestinal bleeding? | 5 years | 
| Patients with diabetes mellitus and systemic corticosteroids | Do systemic corticosteroids increase the risk of exacerbation in patients with diabetes mellitus? | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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multimorbidity, multiple chronic conditions, drug-drug interactions, drug-disease interactions, polypharmacy, Oral anticoagulants, Steroids