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The impact of medication reviews conducted in primary care on hospital admissions and mortality : An observational follow-up of a randomized controlled trial

Nymberg, Veronica Milos LU ; Lenander, Cecilia LU and Bolmsjö, Beata Borgström LU (2021) In Drug, Healthcare and Patient Safety 13. p.1-9
Abstract

Background: Drug-related problems among the elderly population are common and increasing. Multi-professional medication reviews (MR) have arisen as a method to optimize drug therapy for frail elderly patients. Research has not yet been able to show conclusive evidence of the effect of MRs on mortality or hospital admissions. Aim: The aim of this study was to assess the impact of MRs’ on hospital admissions and mortality after six and 12 months in a frail population of 369 patients in primary care in a cohort from a randomized controlled study. Methods: Patients were blindly randomized to an intervention group (receiving MRs) and a control group (receiving usual care). Descriptive data on mortality and hospital admissions at six and 12... (More)

Background: Drug-related problems among the elderly population are common and increasing. Multi-professional medication reviews (MR) have arisen as a method to optimize drug therapy for frail elderly patients. Research has not yet been able to show conclusive evidence of the effect of MRs on mortality or hospital admissions. Aim: The aim of this study was to assess the impact of MRs’ on hospital admissions and mortality after six and 12 months in a frail population of 369 patients in primary care in a cohort from a randomized controlled study. Methods: Patients were blindly randomized to an intervention group (receiving MRs) and a control group (receiving usual care). Descriptive data on mortality and hospital admissions at six and 12 months were collected. Survival analysis was performed for time to death and time to the first hospital admission within 12 months. Results: An observational follow-up was performed in a cohort of 369 patients, previously randomized to an intervention group (182) and a control group (187). Most of the patients (75%) were females and lived in nursing homes. At six months, 50 patients of the baseline population (27%) in the control group had been admitted to hospital at least once, compared to 40 patients (21%) in the intervention group. At 12 months, the percentage had increased to 70 (37%) in the control group compared to 53 (29%) in the intervention group. Compared to usual care, we found that MRs reduced the risk of hospital admissions within 12 months by 42% (HR = 0.58, 95% CI 0.37–0.92, p=0.021), but found no difference in mortality (HR = 1.12, 95% CI 0.78–1.61, p=0.551) between the groups. Conclusion: We suggest that MRs should be recommended in the care of frail elderly patients with expected benefits on delayed hospital admissions. The study is registered at ClinicalTrials.gov, registration number NCT04040855, Unique Protocol ID 2018/8.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Elderly, Hospital admissions, Medication reviews, Mortality, Primary care, Randomized controlled study
in
Drug, Healthcare and Patient Safety
volume
13
pages
9 pages
publisher
Dove Medical Press Limited
external identifiers
  • pmid:33536791
  • scopus:85100565614
ISSN
1179-1365
DOI
10.2147/DHPS.S283708
language
English
LU publication?
yes
id
7197ac85-8893-413d-a3af-5ca5e8136e55
date added to LUP
2021-02-24 09:03:36
date last changed
2021-04-13 05:24:33
@article{7197ac85-8893-413d-a3af-5ca5e8136e55,
  abstract     = {<p>Background: Drug-related problems among the elderly population are common and increasing. Multi-professional medication reviews (MR) have arisen as a method to optimize drug therapy for frail elderly patients. Research has not yet been able to show conclusive evidence of the effect of MRs on mortality or hospital admissions. Aim: The aim of this study was to assess the impact of MRs’ on hospital admissions and mortality after six and 12 months in a frail population of 369 patients in primary care in a cohort from a randomized controlled study. Methods: Patients were blindly randomized to an intervention group (receiving MRs) and a control group (receiving usual care). Descriptive data on mortality and hospital admissions at six and 12 months were collected. Survival analysis was performed for time to death and time to the first hospital admission within 12 months. Results: An observational follow-up was performed in a cohort of 369 patients, previously randomized to an intervention group (182) and a control group (187). Most of the patients (75%) were females and lived in nursing homes. At six months, 50 patients of the baseline population (27%) in the control group had been admitted to hospital at least once, compared to 40 patients (21%) in the intervention group. At 12 months, the percentage had increased to 70 (37%) in the control group compared to 53 (29%) in the intervention group. Compared to usual care, we found that MRs reduced the risk of hospital admissions within 12 months by 42% (HR = 0.58, 95% CI 0.37–0.92, p=0.021), but found no difference in mortality (HR = 1.12, 95% CI 0.78–1.61, p=0.551) between the groups. Conclusion: We suggest that MRs should be recommended in the care of frail elderly patients with expected benefits on delayed hospital admissions. The study is registered at ClinicalTrials.gov, registration number NCT04040855, Unique Protocol ID 2018/8.</p>},
  author       = {Nymberg, Veronica Milos and Lenander, Cecilia and Bolmsjö, Beata Borgström},
  issn         = {1179-1365},
  language     = {eng},
  pages        = {1--9},
  publisher    = {Dove Medical Press Limited},
  series       = {Drug, Healthcare and Patient Safety},
  title        = {The impact of medication reviews conducted in primary care on hospital admissions and mortality : An observational follow-up of a randomized controlled trial},
  url          = {http://dx.doi.org/10.2147/DHPS.S283708},
  doi          = {10.2147/DHPS.S283708},
  volume       = {13},
  year         = {2021},
}