- ICH GCP
- 미국 임상 시험 레지스트리
- 임상시험 NCT03725046
Impact of an Optimized Communication on the Readmission for Adverse Drug Event (URGEIM)
Evaluation of the Impact of an Optimized Communication Between Hospital and Community on the Readmission at the Emergency Department for an Adverse Drug Event : Randomized Controlled Trial
Emergency departments (EDs) are a crucial element of health care systems as they constitute the interface between hospital and communities. The goals of the ED are to make an initial diagnosis and deliver urgent and critical care 24 hours per day and 365 days a year. Also, many Adverse Drug Events (ADEs) are not identified by emergency physicians. ADEs are injuries resulting from a drug related medical intervention. Their detection, documentation and reporting are essential for adequate medical care and knowledge of risk/benefit profiles of medication throughout their lifecycle. However, a number of studies indicate that in clinical practice the under-reporting of ADEs is a pervasive and widespread problem. The main reasons for under-reporting were difficulty in determining the cause of the ADE, lack of time, poor integration of ADE-reporting systems and uncertainty about reporting procedures. Successful treatment of ADEs depends on the ability of physicians to attribute ADEs to a medication. Some studies have reported that not only pharmacists but also pharmacy student were one of the best health care providers to establish medication history and detected ADEs.
It has also been shown that a clinical pharmacist, within the emergency medical team, can improve the detection of ADE through drug expertise and reliable drug history. This approach has been adopted at Montpellier University Hospital since November 2011. During the initial diagnosis of the ADE, the revision of a drug treatment at risk cannot be carried out in emergency department by the emergency physician. Indeed, the latter intervenes punctually but he is not the patient's referring doctor. Guidance and follow-up of the patient throughout the care journey is the responsibility of the referring physician, sometimes accompanied by the pharmacist. It is therefore very important that a relevant information detected at the hospital can be passed on to the referring health professionals who will review and adapt the treatment. The city-hospital link is essential to guarantee the continuity and the consistence of the care process. When a patient is discharging with the emergency department, the outgoing mail often mentions only the reason for admission, and the information concerning the detection or suspicion of an ADE is not systematically stipulated. However, this information is essential to trigger a process of therapeutic revision (therapeutic modification, therapeutic education, referral to specialized consultations ...) that will prevent the recurrence of the ADE and therefore the readmission to emergency department. To date, the rate of readmission to emergency department after a first visit related to an ADE is between 3.6 and 18.7%.
Our goal is to evaluate the impact at 6 months of a medical-pharmaceutical follow-up and the optimization of the city-hospital link following an admission at emergency department for ADE, on the readmission to emergency department for the same ADE.
This is a single-center randomized, controlled, open-label, two-arm, parallel, "usual information transmission" or "optimized information transmission" study. The duration of a patient's follow-up is 6 months.
Each patient with an occurring ADE detected during emergency department admission could be participating in the study.
Specific management of the experimental group: Sending to the community referring physician by the emergency department an discharge report containing the reason for emergency consultations (report currently made as part of the treatment). Within 72 hours (working hours), the Emergency Clinical Pharmacist contacts the referring physician and the patient's community pharmacist to discuss how to manage the ADE. In parallel, a second report, summary of the ADE (ADE-report), is sent to them. The ADE-report, written and validated by the investigators (emergency physician and clinical pharmacist), includes the type of ADE, the suspected drug(s) and other recommendations: therapeutic modification, referral to specialized consultations (geriatrics ...)
Control group: The emergency department sends to the referring doctor a letter to inform him about the reason of consultations in the emergency department (mail currently realized as part of the care process).
Primary outcome measure: Percentage of patients who had at least one readmission for the same reason in the emergency department within 6 months of the initial exit. This information will be collected during a telephone call with the patient and the referring physician.
연구 개요
연구 유형
등록 (실제)
단계
- 해당 없음
연락처 및 위치
연구 장소
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Herault
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Montpellier, Herault, 프랑스, 34295
- University Hospital of Montpellier
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참여기준
자격 기준
공부할 수 있는 나이
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
설명
Inclusion criteria:
- Patient over 18 years old
- Patient to whom an ADE is detected
- Possibility of carrying out a pharmaceutical consultation/interview
- Patient who has consented to participate
- Patient affiliated to the social welfare policy
- Patient who declared a referent medical doctor
Exclusion criteria:
- ADE linked to an emergency care activity
- Voluntary medical intoxication
- Impossibility of recovering the patient's drug history
- Under 18
- Pregnancy
- Participating in another category 1 interventional drug study
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 건강 서비스 연구
- 할당: 무작위
- 중재 모델: 병렬 할당
- 마스킹: 하나의
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
---|---|
간섭 없음: Usual information transmission after ED admission
The emergency department (ED) sends to the referring doctor a letter to inform him about the reason of consultations in the emergency department (mail currently realized as part of the care process).
|
|
실험적: Optimized information transmission after ED admission
Sending to the community referring physician by the emergency department an discharge report containing the reason for emergency consultations (report currently made as part of the treatment).
Within 72 hours (working hours), the Emergency Clinical Pharmacist contacts the referring physician and the patient's community pharmacist to discuss how to manage the ADE.
In parallel, a second report, summary of the ADE (ADE-report), is sent to them.
The ADE-report, written and validated by the investigators (emergency physician and clinical pharmacist), includes the type of ADE, the suspected drug(s) and other recommendations: therapeutic modification, referral to specialized consultations (geriatrics ...).
|
Sending to the community referring physician by the emergency department an discharge report containing the reason for emergency consultations (report currently made as part of the treatment).
Within 72 hours (working hours), the Emergency Clinical Pharmacist contacts the referring physician and the patient's community pharmacist to discuss how to manage the ADE.
In parallel, a second report, summary of the ADE (ADE-report), is sent to them.
The ADE-report, written and validated by the investigators (emergency physician and clinical pharmacist), includes the type of ADE, the suspected drug(s) and other recommendations: therapeutic modification, referral to specialized consultations (geriatrics ...).
|
연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
기간 |
---|---|
Percentage of patients who had at least one readmission in the emergency department for the same reason
기간: within 6 month of the initial visit
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within 6 month of the initial visit
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2차 결과 측정
결과 측정 |
기간 |
---|---|
Percentage of patients who had at least one readmission in the emergency department for any reason
기간: within 6 month of the initial visit
|
within 6 month of the initial visit
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Percentage of patients hospitalized for ADE at least once
기간: within 6 month of the initial visit
|
within 6 month of the initial visit
|
Percentage of patients hospitalized for any reason at least once
기간: within 6 months of the initial visit
|
within 6 months of the initial visit
|
Potentially avoidable hospitalization rate
기간: 6 months
|
6 months
|
Mortality rate related to ADE and all other causes
기간: 6 months
|
6 months
|
Number of medical consultations with a general community practitioner in connection with ADE and all causes combined
기간: 6 months
|
6 months
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Number of medical consultations with a specialist community practitioner in connection with ADE and all causes combined
기간: 6 months
|
6 months
|
공동 작업자 및 조사자
수사관
- 수석 연구원: Maxime VILLIET, PharmD, University Hospital, Montpellier
간행물 및 유용한 링크
연구 기록 날짜
연구 주요 날짜
연구 시작 (실제)
기본 완료 (실제)
연구 완료 (실제)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (실제)
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
추가 관련 MeSH 약관
기타 연구 ID 번호
- UF7591
개별 참가자 데이터(IPD) 계획
개별 참가자 데이터(IPD)를 공유할 계획입니까?
약물 및 장치 정보, 연구 문서
미국 FDA 규제 의약품 연구
미국 FDA 규제 기기 제품 연구
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약물 부작용에 대한 임상 시험
-
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