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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 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.
Abbreviations
DRP, drug-related problem; EMR, electronic medical record; FRIDs, fall risk increasing drugs; GP, general practitioner; MR, medication review; PHCC, primary healthcare center; PIM, potentially inappropriate medication; RCT, randomized controlled trial.
Data Sharing Statement
The datasets used during the current study are available from the corresponding author on reasonable request. The datasets used during the current study are also submitted to Dryad (doi:10.5061/dryad.wm37pvmjv).
Ethics and Consent to Participate
This study was conducted in accordance with the Declaration of Helsinki. The study has been approved by the Regional Ethical Review Board in Lund (Reg. no. 2018/8). Patients were included in the study after they provided written consent directly or through relatives in cases of severe cognitive impairment. The study adheres to CONSORT and STROBE guidelines.
Consent to Publish
We have obtained informed and written consent to publish from all study participants, as required by the Regional Ethical regulations in Sweden.
Acknowledgments
We are indebted to Patrick Reilly for his expertise and invaluable advice in editing the manuscript, Sara Larsson Lönn and Ulf Jakobsson for statistical input.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
Dr Veronica Milos Nymberg reports grants from Lions Forskningsfond Skåne, during the conduct of the study. The authors declare that they have no other potential conflicts of interest for this work.