Importance: Among old people, up to 30% of hospital admissions are directly associated with drug-related problems. Old people with dementia or cognitive impairment are especially vulnerable to adverse drug reactions.
Objective: To evaluate whether comprehensive medication reviews conducted by clinical pharmacists as part of a health care team reduce hospital readmissions rates among old people with dementia or cognitive impairment.
Design: A randomized controlled trial was carried out between January 9, 2012, and December 2, 2014. The total follow-up time was 180 days.
Setting: Patients admitted to acute internal medicine wards at the Skellefteå County Hospital and Umeå University Hospital, and to the orthopedic ward at Umeå University Hospital were included. Both hospitals are located in Northern Sweden.
Participants: Eligible were patients aged 65 years or older with dementia or cognitive impairment. Of the 473 deemed eligible for participation, 230 were randomized to intervention and 230 to control group by block randomization.
Intervention: In addition to standard therapy the intervention group received a standardized medication review performed by experienced clinical pharmacists.
Main Outcomes and Measures: The primary outcome, risk of drug-related hospital readmissions, was assessed at 180 days of follow-up by intention-to-treat analysis.
Results: During the 180 days of follow-up, 19% (40/212) of patients in the intervention group and 23% (50/217) of those in the control group were readmitted for drug-related reasons (hazard ratio [HR], 0.80 [95% CI, 0.53 to 1.21]; P=.28, univariate Cox regression). Heart failure was significantly more common in the intervention group. After adjustment for heart failure as a potential confounder multiple Cox regression analysis indicated that pharmacist participation significantly reduced the risk of drug-related readmissions (HR, 0.49 [95% CI, 0.27 to 0.90]; P=.02).
Conclusions and Relevance: Pharmacist participation in the ward team significantly reduced the rate of drug-related hospital readmissions. However, in a subset of patients with concomitant heart failure only early 30-day readmissions were significantly reduced. Participation of clinical pharmacists in the healthcare team may significantly reduce the risk of drug-related readmissions in patients with dementia or cognitive impairment.
Trial Registration: clinicaltrials.gov Identifier: NCT01504672