Less is More: Optimized Pharmacotherapy with Improved CoNtinuity of CarE in HospitaLized OLder PeOple

Launched by RADBOUD UNIVERSITY MEDICAL CENTER · Jun 2, 2023

Keywords

ClinConnect Summary

This clinical trial, called "Less Is More," is studying a new approach to managing medications for older adults who are taking multiple drugs, a situation known as polypharmacy. It focuses on patients aged 70 and older who have been admitted to the hospital through the emergency department and stay for more than 24 hours. The goal is to see if a special kind of care called transitional multidisciplinary pharmacotherapeutic care (TMPC) can help reduce the number of patients who return to the hospital due to medication-related issues within the first 30 days after leaving. Researchers will also look into whether this new care approach is cost-effective.

To be eligible for this trial, participants must be at least 70 years old, take five or more regular medications, and have a higher risk of medication-related complications. Those who agree to participate will receive care from a specialized team that includes a thorough review of their medications, discussions about their treatment plan, and a detailed care plan to follow after they leave the hospital. It's important to note that certain patients, like those with very short life expectancies or those in specific types of care, cannot participate. This trial is still recruiting participants, and it aims to improve the safety and effectiveness of medication management for older adults.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 70 years or older
• • Polypharmacy, the use of 5 or more regular medications, defined as authorised medications with registration numbers, used for more than 30 days. Topical preparations are excluded from this definition.
• • Admitted to hospital through the ED (which comprises both the general emergency department and the cardiac emergency department)
• • Length of hospitalisation more than 24 hours
• • Completed medication verification
• • DRA prediction percentage of 23.0% or higher
• Exclusion Criteria:
• • No informed consent by patient or a legal representative
• • Participation in an interfering clinical trial
• • Elective hospital admission
• • Direct admission to the ICU (when medication verification as usual can't be executed, and therefore inclusion of patients as described in 10.2 is not possible)
• • A life expectancy of less than 3 months, which includes patients with palliative treatment at home, direct admission to palliative care or palliative care planned within 24 hours after index hospital admission.
• • Patient or legal representative not able to speak Dutch.
• * Follow-up of patient primarily by secondary caregivers. This refers to situations where the secondary caregiver is in the lead of the medication list of the patient instead of the GP or elderly care physician, for example in the following patient groups:
• • patients receiving intensive oncologic therapy
• • patients in an organ- or stem cell transplantation procedure
• • patients receiving intensive (chronic) psychiatric care, such as patients admitted to a medical psychiatric unit
• • patients on dialysis