Control in the Hospital by Extensive Clinical rules for Unplanned hospitalizations in older Patients (CHECkUP); study design of a multicentre randomized study.
Clinical decision support system
Medication optimisation
Older patients
Polypharmacy
Readmissions
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
10 01 2022
10 01 2022
Historique:
received:
01
10
2021
accepted:
15
12
2021
entrez:
11
1
2022
pubmed:
12
1
2022
medline:
27
1
2022
Statut:
epublish
Résumé
Due to ageing of the population the incidence of multimorbidity and polypharmacy is rising. Polypharmacy is a risk factor for medication-related (re)admission and therefore places a significant burden on the healthcare system. The reported incidence of medication-related (re)admissions varies widely due to the lack of a clear definition. Some medications are known to increase the risk for medication-related admission and are therefore published in the triggerlist of the Dutch guideline for Polypharmacy in older patients. Different interventions to support medication optimization have been studied to reduce medication-related (re)admissions. However, the optimal template of medication optimization is still unknown, which contributes to the large heterogeneity of their effect on hospital readmissions. Therefore, we implemented a clinical decision support system (CDSS) to optimize medication lists and investigate whether continuous use of a CDSS reduces the number of hospital readmissions in older patients, who previously have had an unplanned probably medication-related hospitalization. The CHECkUP study is a multicentre randomized study in older (≥60 years) patients with an unplanned hospitalization, polypharmacy (≥5 medications) and using at least two medications from the triggerlist, from Zuyderland Medical Centre and Maastricht University Medical Centre+ in the Netherlands. Patients will be randomized. The intervention consists of continuous (weekly) use of a CDSS, which generates a Medication Optimization Profile, which will be sent to the patient's general practitioner and pharmacist. The control group will receive standard care. The primary outcome is hospital readmission within 1 year after study inclusion. Secondary outcomes are one-year mortality, number of emergency department visits, nursing home admissions, time to hospital readmissions and we will evaluate the quality of life and socio-economic status. This study is expected to add evidence on the knowledge of medication optimization and whether use of a continuous CDSS ameliorates the risk of adverse outcomes in older patients, already at an increased risk of medication-related (re)admission. To our knowledge, this is the first large study, providing one-year follow-up data and reporting not only on quality of care indicators, but also on quality-of-life. The trial was registered in the Netherlands Trial Register on October 14, 2018, identifier: NL7449 (NTR7691). https://www.trialregister.nl/trial/7449 .
Sections du résumé
BACKGROUND
Due to ageing of the population the incidence of multimorbidity and polypharmacy is rising. Polypharmacy is a risk factor for medication-related (re)admission and therefore places a significant burden on the healthcare system. The reported incidence of medication-related (re)admissions varies widely due to the lack of a clear definition. Some medications are known to increase the risk for medication-related admission and are therefore published in the triggerlist of the Dutch guideline for Polypharmacy in older patients. Different interventions to support medication optimization have been studied to reduce medication-related (re)admissions. However, the optimal template of medication optimization is still unknown, which contributes to the large heterogeneity of their effect on hospital readmissions. Therefore, we implemented a clinical decision support system (CDSS) to optimize medication lists and investigate whether continuous use of a CDSS reduces the number of hospital readmissions in older patients, who previously have had an unplanned probably medication-related hospitalization.
METHODS
The CHECkUP study is a multicentre randomized study in older (≥60 years) patients with an unplanned hospitalization, polypharmacy (≥5 medications) and using at least two medications from the triggerlist, from Zuyderland Medical Centre and Maastricht University Medical Centre+ in the Netherlands. Patients will be randomized. The intervention consists of continuous (weekly) use of a CDSS, which generates a Medication Optimization Profile, which will be sent to the patient's general practitioner and pharmacist. The control group will receive standard care. The primary outcome is hospital readmission within 1 year after study inclusion. Secondary outcomes are one-year mortality, number of emergency department visits, nursing home admissions, time to hospital readmissions and we will evaluate the quality of life and socio-economic status.
DISCUSSION
This study is expected to add evidence on the knowledge of medication optimization and whether use of a continuous CDSS ameliorates the risk of adverse outcomes in older patients, already at an increased risk of medication-related (re)admission. To our knowledge, this is the first large study, providing one-year follow-up data and reporting not only on quality of care indicators, but also on quality-of-life.
TRIAL REGISTRATION
The trial was registered in the Netherlands Trial Register on October 14, 2018, identifier: NL7449 (NTR7691). https://www.trialregister.nl/trial/7449 .
Identifiants
pubmed: 35012478
doi: 10.1186/s12877-021-02723-8
pii: 10.1186/s12877-021-02723-8
pmc: PMC8744034
doi:
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
36Informations de copyright
© 2022. The Author(s).
Références
BMC Geriatr. 2020 Nov 11;20(1):467
pubmed: 33176721
Ther Clin Risk Manag. 2015 May 08;11:767-77
pubmed: 26056459
Emerg Med Clin North Am. 2006 May;24(2):449-65, viii
pubmed: 16584966
Drug Saf. 2010 Mar 1;33(3):233-44
pubmed: 20158287
Eur J Clin Pharmacol. 2016 May;72(5):631-9
pubmed: 26884320
J Am Pharm Assoc (2003). 2015 May-Jun;55(3):246-54
pubmed: 26003155
N Engl J Med. 2011 Nov 24;365(21):2002-12
pubmed: 22111719
BMJ. 2009 Jan 07;338:a2752
pubmed: 19129307
J Am Geriatr Soc. 2018 Mar;66(3):602-608
pubmed: 29468640
Springerplus. 2016 Jun 24;5(1):871
pubmed: 27386320
Arch Intern Med. 2008 Sep 22;168(17):1890-6
pubmed: 18809816
Br J Clin Pharmacol. 2010 Nov;70(5):749-55
pubmed: 21039769
Int J Clin Pharm. 2020 Oct;42(5):1243-1251
pubmed: 32472324
Int J Qual Health Care. 2017 Apr 1;29(2):200-205
pubmed: 28453819
J Am Geriatr Soc. 2013 Jan;61(1):113-21
pubmed: 23252914
Aging Clin Exp Res. 2018 Aug;30(8):977-984
pubmed: 29128999
Age Ageing. 2015 Mar;44(2):213-8
pubmed: 25324330
BMC Geriatr. 2018 Jul 3;18(1):155
pubmed: 29970005
J Am Geriatr Soc. 2021 Jun;69(6):1646-1658
pubmed: 33576506
Qual Life Res. 2011 Dec;20(10):1727-36
pubmed: 21479777
Am Health Drug Benefits. 2016 Jul;9(5):259-68
pubmed: 27625743
Hosp Pharm. 2015 Jul;50(7):595-602
pubmed: 26448671
Pharmacoepidemiol Drug Saf. 2008 Apr;17(4):365-71
pubmed: 18302300
JAMA Intern Med. 2018 Mar 1;178(3):375-382
pubmed: 29379953
J Am Geriatr Soc. 2011 May;59(5):948-9
pubmed: 21568972
Int J Clin Pharm. 2013 Oct;35(5):668-72
pubmed: 23888346
Pharmacoepidemiol Drug Saf. 2015 May;24(5):495-503
pubmed: 25683383