Reducing Medical Admissions into Hospital through Optimising Medicines (REMAIN HOME) Study: protocol for a stepped-wedge, cluster-randomised trial

doi:10.1136/bmjopen-2016-015301

Randomized Controlled Trial

. 2017 Apr 13;7(4):e015301.

doi: 10.1136/bmjopen-2016-015301.

Reducing Medical Admissions into Hospital through Optimising Medicines (REMAIN HOME) Study: protocol for a stepped-wedge, cluster-randomised trial

Holly Foot¹, Christopher Freeman², Karla Hemming³, Ian Scott^{4

5}, Ian D Coombes^{1

6}, Ian D Williams^{7

8}, Luke Connelly^{9

10}, Jennifer A Whitty^{1

11}, Nancy Sturman¹, Sue Kirsa^{12

13}, Caroline Nicholson¹⁴, Grant Russell¹⁵, Carl Kirkpatrick¹³, Neil Cottrell¹

Affiliations

¹ School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia.
² School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia c.freeman4@uq.edu.au.
³ Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK.
⁴ Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁵ Southern School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
⁶ Department of Pharmacy, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
⁷ Brisbane South PHN, Brisbane, Australia.
⁸ School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
⁹ Centre for the Business and Economics of Health, University of Queensland, Brisbane, Queensland, Australia.
¹⁰ Poche Centre for Indigenous Health, University of Queensland, Brisbane, Queensland, Australia.
¹¹ Faculty of Medicine and Health Sciences, University of East Anglia Norwich Medical School, Norwich, UK.
¹² Department of Pharmacy, Monash Health, Clayton, Victoria, Australia.
¹³ Centre for Medicine Use and Safety, Monash University Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia.
¹⁴ Mater Misericordiae Health Services Brisbane Ltd, South Brisbane, Queensland, Australia.
¹⁵ School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia.

PMID: 28408545
PMCID: PMC5719661
DOI: 10.1136/bmjopen-2016-015301

Randomized Controlled Trial

Reducing Medical Admissions into Hospital through Optimising Medicines (REMAIN HOME) Study: protocol for a stepped-wedge, cluster-randomised trial

Holly Foot et al. BMJ Open. 2017.

. 2017 Apr 13;7(4):e015301.

doi: 10.1136/bmjopen-2016-015301.

Authors

Affiliations

¹ School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia.
² School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia c.freeman4@uq.edu.au.
³ Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK.
⁴ Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁵ Southern School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
⁶ Department of Pharmacy, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
⁷ Brisbane South PHN, Brisbane, Australia.
⁸ School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
⁹ Centre for the Business and Economics of Health, University of Queensland, Brisbane, Queensland, Australia.
¹⁰ Poche Centre for Indigenous Health, University of Queensland, Brisbane, Queensland, Australia.
¹¹ Faculty of Medicine and Health Sciences, University of East Anglia Norwich Medical School, Norwich, UK.
¹² Department of Pharmacy, Monash Health, Clayton, Victoria, Australia.
¹³ Centre for Medicine Use and Safety, Monash University Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia.
¹⁴ Mater Misericordiae Health Services Brisbane Ltd, South Brisbane, Queensland, Australia.
¹⁵ School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia.

PMID: 28408545
PMCID: PMC5719661
DOI: 10.1136/bmjopen-2016-015301

Abstract

Introduction: A model of general practitioner (GP) and pharmacist collaboration in primary care may be an effective strategy to reduce medication-related problems and provide better support to patients after discharge. The aim of this study is to investigate whether a model of structured pharmacist and GP care reduces hospital readmissions in high-risk patients.

Methods and analysis: This protocol details a stepped-wedge, cluster-randomised trial that will recruit participants over 9 months with a 12-month follow-up. There will be 14 clusters each representing a different general practice medical centre. A total of 2240 participants will be recruited from hospital who attend an enrolled medical centre, take five or more long-term medicines or whose reason for admission was related to heart failure or chronic obstructive pulmonary disease.The intervention is a multifaceted service, involving a pharmacist integrated into a medical centre to assist patients after hospitalisation. Participants will meet with the practice pharmacist and their GP after discharge to review and reconcile their medicines and discuss changes made in hospital. The pharmacist will follow-up with the participant and liaise with other health professionals involved in the participant's care. The control will be usual care, which usually involves a patient self-organising a visit to their GP after hospital discharge.The primary outcome is the rate of unplanned, all-cause hospital readmissions over 12 months, which will be analysed using a mixed effects Poisson regression model with a random effect for cluster and a fixed effect to account for any temporal trend. A cost analysis will be undertaken to compare the healthcare costs associated with the intervention to those of usual care.

Ethics and dissemination: The study has received ethical approval (HREC/16/QRBW/410). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders.

Trial registration number: ACTRN12616001627448.

Keywords: Readmission; collaboration; medication; pharmacist; primary care; stepped-wedge cluster design.

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Conflict of interest statement

Competing interests: IW is the chair of Brisbane South PHN. This position is not dependent on the success of the project. Representatives of the HCF Research Foundation, Brisbane South PHN and Brisbane North PHN have been invited to be a part of the project reference group to provide input and advice on the study design. The project reference group plays no role in data analysis, interpretation of data or the decision to submit findings for publication.

Figures

**Figure 1**
Schematic representation of the stepped-wedge study design.

**Figure 2**
Diagram of REMAIN HOME patient recruitment, randomisation, intervention and control arms. COPD, chronic obstructive pulmonary disease; GP, general practitioner; REMAIN HOME, Reducing Medical Admissions into Hospital through Optimising Medicines.

See this image and copyright information in PMC

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References

1. Australian Council on Safety and Quality in Health Care. Second national report on improving patient safety: improving medication safety. Canberra: Australian Council on Safety and Quality in Health Care, 2002.
1. Howell S, Coory M, Martin J, et al. . Using routine inpatient data to identify patients at risk of hospital readmission. BMC Health Serv Res 2009;9:1–9. 10.1186/1472-6963-9-96 - DOI - PMC - PubMed
1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009;360:1418–28. 10.1056/NEJMsa0803563 - DOI - PubMed
1. Davies EC, Green CF, Mottram DR, et al. . Emergency re-admissions to hospital due to adverse drug reactions within 1 year of the index admission. Br J Clin Pharmacol 2010;70:749–55. 10.1111/j.1365-2125.2010.03751.x - DOI - PMC - PubMed
1. Wimmer BC, Dent E, Bell JS, et al. . Medication regimen complexity and unplanned hospital readmissions in older people. Ann Pharmacother 2014;48:1120–8. 10.1177/1060028014537469 - DOI - PubMed

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[1] Australian Council on Safety and Quality in Health Care. Second national report on improving patient safety: improving medication safety. Canberra: Australian Council on Safety and Quality in Health Care, 2002.

[2] Australian Council on Safety and Quality in Health Care. Second national report on improving patient safety: improving medication safety. Canberra: Australian Council on Safety and Quality in Health Care, 2002.

[3] Howell S, Coory M, Martin J, et al. . Using routine inpatient data to identify patients at risk of hospital readmission. BMC Health Serv Res 2009;9:1–9. 10.1186/1472-6963-9-96 - DOI - PMC - PubMed

[4] Howell S, Coory M, Martin J, et al. . Using routine inpatient data to identify patients at risk of hospital readmission. BMC Health Serv Res 2009;9:1–9. 10.1186/1472-6963-9-96 - DOI - PMC - PubMed

[5] Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009;360:1418–28. 10.1056/NEJMsa0803563 - DOI - PubMed

[6] Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009;360:1418–28. 10.1056/NEJMsa0803563 - DOI - PubMed

[7] Davies EC, Green CF, Mottram DR, et al. . Emergency re-admissions to hospital due to adverse drug reactions within 1 year of the index admission. Br J Clin Pharmacol 2010;70:749–55. 10.1111/j.1365-2125.2010.03751.x - DOI - PMC - PubMed

[8] Davies EC, Green CF, Mottram DR, et al. . Emergency re-admissions to hospital due to adverse drug reactions within 1 year of the index admission. Br J Clin Pharmacol 2010;70:749–55. 10.1111/j.1365-2125.2010.03751.x - DOI - PMC - PubMed

[9] Wimmer BC, Dent E, Bell JS, et al. . Medication regimen complexity and unplanned hospital readmissions in older people. Ann Pharmacother 2014;48:1120–8. 10.1177/1060028014537469 - DOI - PubMed

[10] Wimmer BC, Dent E, Bell JS, et al. . Medication regimen complexity and unplanned hospital readmissions in older people. Ann Pharmacother 2014;48:1120–8. 10.1177/1060028014537469 - DOI - PubMed

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Reducing Medical Admissions into Hospital through Optimising Medicines (REMAIN HOME) Study: protocol for a stepped-wedge, cluster-randomised trial

Affiliations

Reducing Medical Admissions into Hospital through Optimising Medicines (REMAIN HOME) Study: protocol for a stepped-wedge, cluster-randomised trial

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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Publication types

MeSH terms

Associated data

LinkOut - more resources

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