- ICH GCP
- 미국 임상 시험 레지스트리
- 임상시험 NCT01897870
The Effect of a Pharmacist Home Visit on Drug-related Problems Post-discharge. (HomeCoMe)
2016년 2월 22일 업데이트: H.T. Ensing, PharmD, MSc
The Effect of a Home-based Community Pharmacist-led Medication Management Program (HomeCoMe-program) Complementary to an In-hospital Medication Reconciliation Program on Drug-related Problems Post-discharge: A Prospective Cohort Study.
the purpose of this study is to determine the the effect of a home-based medication management program on drug-related problems post-discharge.
연구 개요
상세 설명
Inaccuracy of medication histories and lack of knowledge on actual medication use results in confusion about medication regimens and medication mismanagement before- during - and after hospital admission.
This phenomenon accounts for many readmissions, longer duration of admission and preventable and serious Adverse Drug Events (ADEs) as a result of Drug Related Problems (DRPs).
Several studies show that discharge medication reconciliation (MR) and counseling by a pharmacy employee reduces the amount of discrepancies in the discharge prescription lists.
Still, no unequivocal effect of MR on the occurrence of DRPs after discharge has been shown.
This is due to a shift in underlying potential harmful discrepancies from mainly patient based (unintended nonadherence) to mainly system based (eg dispensing errors) and might be explained by (1) suboptimal transfer of information (2) an overload of information during a stressful situation and (3) difficulty to implement changes in medication at home.
Therefore the reduction of DRPs, improvement of patients' medication knowledge and initial adherence can probably most effectively be addressed in a multifaceted integrated transmural intervention.
Repetition of important information is the key to success.
Moreover, the first weeks following hospital discharge are most crucial in preventing drug-related problems as patients could slip back in old medication schemes, or new problems may arise, such as emerging ADEs due to medication changes made during hospitalization.
연구 유형
중재적
등록 (실제)
150
단계
- 해당 없음
연락처 및 위치
이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.
연구 장소
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Flevoland
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Almere, Flevoland, 네덜란드, 1315RA
- Zorgapotheken Flevoland
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참여기준
연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.
자격 기준
공부할 수 있는 나이
18년 이상 (성인, 고령자)
건강한 자원 봉사자를 받아들입니다
아니
연구 대상 성별
모두
설명
Inclusion Criteria:
- patient uses more than three prescribed systemic drugs intended for chronic use at admission and discharge
- patient has an expected length of stay of 48 hours or longer
Exclusion Criteria:
- Patients admitted for scheduled chemotherapy
- Patients admitted for radiation therapy
- Patients admitted for transplantation
- Patients transferred from another hospital
- Patients transferred from another non-eligible ward within the same hospital
- No informed consent signed
- A live expectancy less than 6 months
- Inability to be counselled (e.g. cognitive dysfunction, language constraints who cannot be solved with an interpreter)
- Discharge to a nursing home (presuming dependence on medication administration)
- If patients' community pharmacy is not participating in this study
공부 계획
이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 지지 요법
- 할당: 해당 없음
- 중재 모델: 단일 그룹 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
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실험적: HomeCoMe-program group
the arm receiving the pharmacist home visit
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A home visit by patients own community pharmacist within seven days after hospital discharge.
The community pharmacist will perform a semi-structured interview on (1) use of the prescribed medication, (2) ADEs, (3) adherence issues, by (A) assessing patient's needs and concerns around his pharmacotherapy, (B) identifying and solving obstacles for medicines intake, (C) checking on the need for a compliance aid, (D) collecting spare medication and finally (4) knowledge on medication use, when to take which medicine and why, and medication changes made during the hospitalisation.
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
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Identifying and solving adverse drug events (ADEs) and other drug-related problems (DRPs) post-discharge
기간: within 7 days post-discharge
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The total number of assessed and solved ADEs post-discharge will be measured. Assessing and solving ADEs takes place during the pharmacist home visit. Using START-STOPP criteria on patients medication records, ADEs will also be compared between the intervention and usual care group. |
within 7 days post-discharge
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
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Improvement of adherence to medication at hospital discharge
기간: up to 6 months after discharge
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The "medication possession ratio" will be calculated retrospectively from pharmacy dispensing data after 6 months to investigate patient's adherence and compared between the intervention and control group.
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up to 6 months after discharge
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Patient assessment of medication knowledge at time of home visit
기간: within 7 days after discharge
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At time of the home visit patients are asked about their knowledge (e.g.
indication, dose regime, etc) regarding the medication they are taking.
Knowledge is scored and lack of knowledge is solved by teaching the patient.
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within 7 days after discharge
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Types of interventions made at the pharmacist home visit
기간: within 7 days after discharge
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The types of intervention the pharmacist works on during the 7 day follow-up home visit are assessed.
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within 7 days after discharge
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Patient satisfaction with the pharmacist home visit
기간: Immediately after receiving the home visit
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The satisfaction survey consists of 13 interview questions, where the subject subjectively scores each question on a four-point scale, developed specifically for this study.
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Immediately after receiving the home visit
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Assessment of patient reported health rating
기간: at 14 days after discharge
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Patient are asked by telephone to report their health on a scale from 1 (worst imaginable health) to 10 (best imaginable health).
Number are compared between the intervention and control group.
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at 14 days after discharge
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General practitioners satisfaction with the pharmacist home visit
기간: Immediately after the home visit is executed
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The satisfaction survey consists of 13 interview questions, where the subject subjectively scores each question on a four-point scale, developed specifically for this study.
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Immediately after the home visit is executed
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Assessment of patient reported health rating
기간: at 42 days after discharge
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Patient are asked by telephone to report their health on a scale from 1 (worst imaginable health) to 10 (best imaginable health).
Number are compared between the intervention and control group.
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at 42 days after discharge
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공동 작업자 및 조사자
여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.
수사관
- 수석 연구원: Marcel L Bouvy, Prof, PharmD, PhD, UIPS
간행물 및 유용한 링크
연구에 대한 정보 입력을 담당하는 사람이 자발적으로 이러한 간행물을 제공합니다. 이것은 연구와 관련된 모든 것에 관한 것일 수 있습니다.
일반 간행물
- Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, Kachalia A, Horng M, Roy CL, McKean SC, Bates DW. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006 Mar 13;166(5):565-71. doi: 10.1001/archinte.166.5.565.
- Al-Rashed SA, Wright DJ, Roebuck N, Sunter W, Chrystyn H. The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol. 2002 Dec;54(6):657-64. doi: 10.1046/j.1365-2125.2002.01707.x.
- Kwint HF, Faber A, Gussekloo J, Bouvy ML. The contribution of patient interviews to the identification of drug-related problems in home medication review. J Clin Pharm Ther. 2012 Dec;37(6):674-80. doi: 10.1111/j.1365-2710.2012.01370.x. Epub 2012 Aug 3.
연구 기록 날짜
이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.
연구 주요 날짜
연구 시작
2013년 11월 1일
기본 완료 (실제)
2016년 2월 1일
연구 완료 (실제)
2016년 2월 1일
연구 등록 날짜
최초 제출
2013년 7월 2일
QC 기준을 충족하는 최초 제출
2013년 7월 9일
처음 게시됨 (추정)
2013년 7월 12일
연구 기록 업데이트
마지막 업데이트 게시됨 (추정)
2016년 2월 23일
QC 기준을 충족하는 마지막 업데이트 제출
2016년 2월 22일
마지막으로 확인됨
2016년 2월 1일
추가 정보
이 연구와 관련된 용어
이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .
약물 부작용에 대한 임상 시험
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University Hospitals Cleveland Medical CenterWashington University School of Medicine; Case Western Reserve University; Papua New Guinea... 그리고 다른 협력자들모병Mass Drug Administration에 의한 림프 사상충증 제거 | 림프 사상충증에 대한 대량 의약품 관리의 모니터링 및 평가 | 림프 사상충증에 대한 대량 의약품 허가 승인파푸아 뉴기니
HomeCoMe-program에 대한 임상 시험
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Children's Hospital Medical Center, CincinnatiNational Institute of Mental Health (NIMH)완전한
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University of LiverpoolLondon School of Hygiene and Tropical Medicine; National Institute of Mental Health (NIMH)완전한
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University of Texas Southwestern Medical CenterNational Institute on Minority Health and Health Disparities (NIMHD)초대로 등록
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Children's Health모집하지 않고 적극적으로
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KK Women's and Children's HospitalDuke University; Duke-NUS Graduate Medical School; Health Promotion Board, Singapore; Sport...완전한
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Emory University모병
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Microclinic InternationalRoyal Health Awareness Society (RHAS); Jordanian Ministry of Health (MoH)완전한고혈당증 | 고혈압 | 비만 | 제2형 당뇨병 | 진성 당뇨병 | 당뇨병 | 체중 | 체중 감량 | 혈압 | 살찌 다 | 사회적 행동 | 몸무게, 몸 | 포도당, 고지혈증 | 라이프스타일, 건강 | 체중 변화, 신체 | 행동, 건강 | 라이프스타일 위험 감소 | 혈압, 높음 | 고혈당증(당뇨병) | 체중 변화 궤적요르단
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IWK Health CentreCanadian Institutes of Health Research (CIHR)완전한