Assessing the benefit of inclusion of a clinical pharmacist in the health care team to reduce drug-related problems and re-admissions to hospital among elderly patients - a randomized controlled trial

Drug-related problems (DRPs) are a major cause of unplanned hospital admissions among elderly people, and transitions of care have been emphasised as a key area for improving patient safety.

We have designed a complex clinical pharmacist intervention that targets people ≥75-years of age undergoing transitions of care from hospital to home and primary care.

The main objective is to investigate if the intervention can reduce the risk of unplanned drug-related readmission within the first 180 days after the person is discharged from hospital.This is a randomised, controlled, superiority trial with two parallel arms. A total of 700 people ≥75-years will be assigned to either intervention or routine care (control).

As the primary outcome, we will measure time until unplanned drug- related readmission within 30 and 180 days of leaving hospital and use log rank tests and Cox proportional hazard models to analyse differences between the groups.

Further investigations of subgroup effects and adjustments of the regression models will be based on heart failure and cognitive impairment as prognostic factors.The intervention, which aims to find and manage DRPs, is initiated within a week of the person being discharged from hospital and combines repeated medical chart reviews, phone interviews and in some cases medication reviews.

People in both study arms may have been the subject of a medication review during their ward stay.