Article Text

Original research
Effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial
  1. Marianne Lea1,
  2. Morten Mowé2,3,
  3. Espen Molden4,5,
  4. Kristin Kvernrød1,
  5. Eva Skovlund6,
  6. Liv Mathiesen4,7
  1. 1Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
  2. 2General Internal Medicine Ward, the Medical Clinic, Oslo University Hospital, Oslo, Norway
  3. 3Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  4. 4Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
  5. 5Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
  6. 6Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
  7. 7Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
  1. Correspondence to Dr Marianne Lea; marianne.lea{at}sykehusapotekene.no

Abstract

Objective To investigate the effect of pharmacist-led medicines management in multimorbid, hospitalised patients on long-term hospital readmissions and survival.

Design Parallel-group, randomised controlled trial.

Setting Recruitment from an internal medicine hospital ward in Oslo, Norway. Patients were enrolled consecutively from August 2014 to the predetermined target number of 400 patients. The last participant was enrolled March 2016. Follow-up until 31 December 2017, that is, 21–40 months.

Participants Acutely admitted multimorbid patients ≥18 years, using minimum four regular drugs from minimum two therapeutic classes. 399 patients were randomly assigned, 1:1, to the intervention or control group. After excluding 11 patients dying in-hospital and 2 erroneously included, the primary analysis comprised 386 patients (193 in each group) with median age 79 years (range 23–96) and number of diseases 7 (range 2–17).

Intervention Intervention patients received pharmacist-led medicines management comprising medicines reconciliation at admission, repeated medicines reviews throughout the stay and medicines reconciliation and tailored information at discharge, according to the integrated medicines management model. Control patients received standard care.

Primary and secondary outcome measures The primary endpoint was difference in time to readmission or death within 12 months. Overall survival was a priori the clinically most important secondary endpoint.

Results Pharmacist-led medicines management had no significant effect on the primary endpoint time to readmission or death within 12 months (median 116 vs 184 days, HR 0.82, 95% CI 0.64 to 1.04, p=0.106). A statistically significantly increased overall survival was observed during 21–40 months follow-up (HR 0.66, 95% CI 0.48 to 0.90, p=0.008).

Conclusions Pharmacist-led medicines management had no statistically significant effect on time until readmission or death. A statistically significant increased overall survival was seen. Further studies should be conducted to investigate the effect of such an intervention on a larger scale.

Trial registration number NCT02336113.

  • quality in health care
  • internal medicine
  • public health
  • therapeutics
  • clinical pharmacology

Data availability statement

Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from Oslo University Hospital but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Deidentified participant data are however available from the authors on reasonable request and with permission of Oslo University Hospital, with publication. Additional related documents, for example, patient consent forms, are available at request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from Oslo University Hospital but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Deidentified participant data are however available from the authors on reasonable request and with permission of Oslo University Hospital, with publication. Additional related documents, for example, patient consent forms, are available at request.

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Footnotes

  • Correction notice This article has been corrected since it was published. DOI link has been included in the prepublication history. The provenance and peer review statement has been included.

  • Contributors ML: conceptualisation, formal analysis, funding acquisition, investigation, methodology, project administration, software, writing—original draft, writing—review and editing. MM: conceptualisation, funding acquisition, methodology, project administration, supervision, writing—review and editing. EM: conceptualisation, funding acquisition, methodology, supervision, writing—review and editing. KK: investigation, methodology, resources, writing—review and editing. ES: conceptualisation, formal analysis, funding acquisition, methodology, writing—review and editing. LM: conceptualisation, formal analysis, funding acquisition, methodology, project administration, supervision, writing—original draft, writing—review and editing.

  • Funding This work was supported by South-Eastern Norway Regional Health Authority (Ph.D. grant number 12/00718 to author ML). Additional support was provided by the Hospital Pharmacies Enterprise and Oslo University Hospital and Diakonhjemmet hospital.

  • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

    Data from the Norwegian Patient Registry has been used in this publication. The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by the Norwegian Patient Registry is intended nor should be inferred.

  • Competing interests ML received Ph.D. funding from the South-Eastern Norway Regional Health Authority (grant number 12/00718).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.