Implementation of a medicine management plan (MMP) to reduce medication-related harm (MRH) in older people post-hospital discharge

Implementation of a medicine management plan (MMP) to reduce medication-related harm (MRH) in older people post-hospital discharge: a randomised controlled trial

Ali, Khalid (University of Sussex)
Mensah, Ekow A. (University of Sussex)
McDermott, Eugene Ace (University of Sussex)
Kirkham, Frances A. (University of Sussex)
Stevenson, Jennifer (King’s College London)
Hamer, Victoria (Kingston University)
Parekh, Nikesh (University of Sussex)
Schiff, Rebekah (St. Tomas Hospital, London)
van der Cammen, T.J.M. (TU Delft Applied Ergonomics and Design; Erasmus MC)

2022

Background: Medication-related harm (MRH) is an escalating global challenge especially among older adults. The period following hospital discharge carries high-risk for MRH due to medication discrepancies, limited patient/carer education and support, and poor communication between hospital and community professionals. Discharge Medical Service (DMS), a newly introduced NHS scheme, aims to reduce post-discharge MRH through an electronic communication between hospital and community pharmacists. Our study team has previously developed a risk-prediction tool (RPT) for MRH in the 8-weeks period post discharge from a UK hospital cohort of 1280 patients. In this study, we aim to find out if a Medicines Management Plan (MMP) linked to the DMS is more effective than the DMS alone in reducing rates of MRH. Method: Using a randomized control trial design, 682 older adults ≥ 65 years due to be discharged from hospital will be recruited from 4 sites. Participants will be randomized to an intervention arm (individualised medicine management plan (MMP) plus DMS) or a control arm (DMS only) using a 1:1 ratio stratification. Baseline data will include patients’ clinical and social demographics, and admission and discharge medications. At 8-weeks post-discharge, a telephone interview and review of GP records by the study pharmacist will verify MRH in both arms. An economic and process evaluation will assess the cost and acceptability of the study methods. Data analysis: Univariate analysis will be done for baseline variables comparing the intervention and control arms. A multivariate logistic regression will be done incorporating these variables. Economic evaluation will compare the cost-of-service use among the study arms and modelled to provide national estimates. Qualitative data from focus-group interviews will explore practitioners’ understanding, and acceptance of the MMP, DMS and the RPT. Conclusion: This study will inform the use of an objective, validated RPT for MRH among older adults after hospital discharge, and provide a clinical, economic, and service evaluation of a specific medicines management plan alongside the DMS in the National Health Service (UK).

Cost
Discharge
Harm
Hospital
Medication
Model
Older people
Prediction
Risk

http://resolver.tudelft.nl/uuid:5a357b78-b62e-4222-b306-290b6141f4e2

https://doi.org/10.1186/s12877-022-03555-w

1471-2318

BMC Geriatrics, 22 (1)

Institutional Repository

journal article

© 2022 Khalid Ali, Ekow A. Mensah, Eugene Ace McDermott, Frances A. Kirkham, Jennifer Stevenson, Victoria Hamer, Nikesh Parekh, Rebekah Schiff, T.J.M. van der Cammen, More Authors