Steven M. Belknap, MD
In patients ≥ 80 years of age who are admitted to an acute internal medicine ward, does a comprehensive pharmacist intervention reduce subsequent hospital visits?
Randomized controlled trial. ClinicalTrials.gov NCT00661310.
2 acute internal medicine wards in Uppsala, Sweden.
400 patients ≥ 80 years of age (mean age 87 y, 59% women) who were admitted to either of the study wards. Exclusion criteria were scheduled or previous admission to either of the wards during the study period.
Comprehensive pharmacist intervention (n = 199) or usual care (n = 201). The pharmacist intervention involved compilation of current medications from various sources and pharmacist interviews with patients or their caregivers about drug therapy adherence, problems, and over-the-counter drugs. During the inpatient stay, the pharmacist reviewed each patient’s drug therapy, discussed drug-related problems with the health care team, and counseled patients on drug changes. At discharge, the pharmacist provided each patient and the patient’s general practitioner with a summary of drug changes, rationale for the changes, therapeutic goals, and any unresolved drug-related problems. 2 months after discharge, the pharmacist contacted each patient by telephone. The control group received usual care without pharmacist involvement at the ward level.
Hospital visits (emergency department and readmissions). Secondary outcomes included individual components of the composite endpoint, drug-related readmissions, and overall survival.
The main results are in the Table.
A comprehensive pharmacist intervention in elderly patients admitted to internal medicine wards reduced overall hospital visits, emergency department visits, and drug-related readmissions but did not affect overall readmissions or survival.
Comprehensive pharmacist intervention vs usual care for elderly patients admitted to acute internal medicine wards†
†OR = odds ratio. OR and CI defined in Glossary.
‡Readmissions plus emergency department visits.
§Comparison based on Cox proportional hazards model for survival data using relative risks.
Belknap SM. A ward-based pharmacist intervention reduced emergency department visits and drug-related readmissions in elderly patients. Ann Intern Med. ;151:JC3–14. doi: 10.7326/0003-4819-151-6-200909150-02014
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Published: Ann Intern Med. 2009;151(6):JC3-14.
Emergency Medicine, Geriatric Medicine, Hospital Medicine.
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