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Randomized Controlled Trial
. 2020 Oct;45(5):1021-1029.
doi: 10.1111/jcpt.13128. Epub 2020 Mar 14.

Intervention fidelity and process outcomes of medication reviews including post-discharge follow-up in older hospitalized patients: Process evaluation of the MedBridge trial

Thomas G H Kempen  1   2 , Henrik Cam  1   3 , Amanda Kälvemark  1 , Karl-Johan Lindner  4 , Håkan Melhus  2 , Elisabet I Nielsen  3 , Johanna Sulku  5   6 , Ulrika Gillespie  1   3
Affiliations
Randomized Controlled Trial

Intervention fidelity and process outcomes of medication reviews including post-discharge follow-up in older hospitalized patients: Process evaluation of the MedBridge trial

Thomas G H Kempen et al. J Clin Pharm Ther. 2020 Oct.

Abstract

What is known and objective: Drug-related problems (DRPs) are a growing healthcare burden worldwide. In an ongoing cluster-randomized controlled trial in Sweden (MedBridge), comprehensive medication reviews (CMRs) including post-discharge follow-up have been conducted in older hospitalized patients to prevent and solve DRPs. As part of a process evaluation of the MedBridge trial, this study aimed to assess the intervention fidelity and process outcomes of the trial's interventions.

Methods: For intervention delivery, the percentage of patients that received intervention components was calculated per study group. Process outcomes, measured in about one-third of all intervention patients, included the following: the number of identified medication discrepancies, DRPs and recommendations to solve DRPs, correction rate of discrepancies, and implementation rate of recommendations.

Results and discussion: The MedBridge trial included 2637 patients (mean age: 81 years). The percentage of intervention patients (n = 1745) that received the intended intervention components was 94%-98% during admission, and 40%-81% upon and after discharge. The percentage of control patients (n = 892) that received at least one unintended intervention component was 15%. On average, 1.1 discrepancies and 2.0 DRPs were identified in 652 intervention patients. The correction and implementation rates were 79% and 73%, respectively. Stop medication was the most frequently implemented recommendation (n = 293) and 77% of the patients had at least one corrected discrepancy or implemented recommendation.

What is new and conclusion: The intervention fidelity within the MedBridge trial was high for CMRs during hospital stay and lower for intervention components upon and after discharge. The high prevalence of corrected discrepancies and implemented recommendations may explain potential effects of CMRs in the MedBridge trial.

Keywords: clinical trial; drug therapy; implementation science; pharmaceutical services; quality of health care.

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References

REFERENCES

    1. Strand L, Morely P, Cipolle R, Ramsey R, Lamsam G. Drug-related problems: their structure and function. Ann Pharmacother. 1990;24:1093-1097.
    1. Foulon V, Wuyts J, Desplenter F, et al. Problems in continuity of medication management upon transition between primary and secondary care: patients' and professionals' experiences. Acta Clin Belg. 2018;74(4):263-271.
    1. World Health Organization. Medication safety in transitions of care. Geneva, Switzerland; 2019.
    1. Chiatti C, Bustacchini S, Furneri G, et al. The economic burden of inappropriate drug prescribing, lack of adherence and compliance, adverse drug events in older people. Drug Saf. 2012;35:73-87.
    1. Donaldson LJ, Kelley ET, Dhingra-Kumar N, Kieny M-P, Sheikh A. Medication without harm: WHO's third global patient safety challenge. Lancet. 2017;389:1680-1681.

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