Medication Reviews Bridging Healthcare (MedBridge): Study protocol for a pragmatic cluster-randomised crossover trial

Thomas G.H. Kempen, Maria Bertilsson, Karl-Johan Lindner, Johanna Sulku, Elisabet I. Nielsen, Angelica Högberg, Tomas Vikerfors, Håkan Melhus, Ulrika Gillespie

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background
Mismanaged prescribing and use of medication among elderly puts major pressure on current healthcare systems. Performing a medication review, a structured critical examination of a patient's medications, during hospital stay with active follow-up into primary care could optimise treatment benefit and minimise harm. However, a lack of high quality evidence inhibits widespread implementation. This manuscript describes the rationale and design of a pragmatic cluster-randomised, crossover trial to fulfil this need for evidence.

Aim
To study the effects of hospital-initiated comprehensive medication reviews, including active follow-up, on elderly patients' healthcare utilisation compared to 1) usual care and 2) solely hospital based reviews.

Design
Multicentre, three-treatment, replicated, cluster-randomised, crossover trial.

Setting
8 wards with a multidisciplinary team within 4 hospitals in 3 Swedish counties.

Participants
Patients aged 65 years or older, admitted to one of the study wards.

Exclusion criteria
Palliative stage; residing in other than the hospital's county; medication review within the last 30 days; one-day admission.

Interventions
1, comprehensive medication review during hospital stay; 2, same as 1 with the addition of active follow-up into primary care; 3, usual care.

Primary outcome measure
Incidence of unplanned hospital visits during a 12-month follow-up period.

Data collection and analyses
Extraction and collection from the counties' medical record system into a GCP compliant electronic data capture system. Intention-to-treat-analyses using hierarchical models.

Relevance
This study has a high potential to show a reduction in elderly patients' morbidity, contributing to more sustainable healthcare in the long run.
Original languageEnglish
Pages (from-to)126-132
JournalContemporary Clinical Trials
Volume61
DOIs
Publication statusPublished - Oct 2017

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