The Influence of Clinical Pharmacist on the Quality of Drug Prescribing and Rehabilitation Outcomes in Post-acute Hip Fractured Patients

NCT04360746 | Completed

• 1 other identifier: 0832-19-RMC
• Study Type: interventional
• Target: 200
• Locations: 1 country
• Sites: 1

Brief Summary

The influence of clinical pharmacist on various drug related outcomes was reported in different healthcare setting including the community, long term care and during acute hospitalization. Nevertheless, data on the influence of clinical pharmacist intervention on the quality of drug prescribing and rehabilitation outcomes in post-acute hip fractured patients is scarce. The aims of the current study are to evaluate the contribution of a clinical pharmacist on the appropriateness of drug prescribing among post-acute geriatric hip fractured patients and to investigate whether this involvement can improve rehabilitation outcomes. The investigators hypothesis is that early review of geriatric hip fractured patients medical record by a clinical pharmacist will improve the appropriateness of drug treatment and the rehabilitation outcomes among this population.

Conditions

Hip Fractures; Clinical Pharmacists; Rehabilitation Outcome

Outcome Measures

Primary Outcomes (8)

• Summated Medication Appropriateness Index (MAI) score

  The change from admission to discharge in the summated medication appropriateness index score. Each medication can get a score between 0-18, with a higher score indicating inappropriateness of more drug elements.

  Admission (baseline value) and at discharge (approximately 5 weeks post admission)

• Anticholinergic Cognitive Burden (ACB) score

  The change from admission to discharge in the anticholinergic cognitive burden score. Each medication can get a score between 0-3, with a higher score indicating a higher anticholinergic burden.

  Admission (baseline value) and at discharge (approximately 5 weeks post admission)

• The change in medication discrepancy

  The number of medication discrepancy and underuse of drugs

  Admission (baseline value) and at discharge (approximately 5 weeks post admission)

• The change in overused drugs

  The number of overused or misused drugs

  Admission (baseline value) and at discharge (approximately 5 weeks post admission)

• The change in Functional Independence measure (FIM) score

  The change from admission to discharge in the Functional Independence measure score. the score is calculated for each patient and can be between 18-126, with a higher score indicating a better functional independence status.

  Admission (baseline value) and at discharge (approximately 5 weeks post admission)

• The change in motor functional independence measure (mFIM)

  The change from admission to discharge in motor functional independence measure score. the score is calculated for each patient and can be between 18-91, with a higher score indicating a better motor functional independence status.

  Admission (baseline value) and at discharge (approximately 5 weeks post admission)

• The change in Montebello Rehabilitation Factor Score (MRFS)

  The relative functional gain (motor functional independence measure effectiveness) achieved on the motor functional independence measure score. The Montebello Rehabilitation Factor Score (MRFS) is calculated as the motor functional independence measure score change (discharge score minus admission score) divided by the motor functional independence measure maximum score (a score of 91) minus the motor functional independence measure admission score. The Montebello Rehabilitation Factor Score can be between -80 to 100 with a higher score indicating a better motor functional independence measure effectiveness (a higher relative functional gain during rehabilitation).

  Admission (baseline value) and at discharge (approximately 5 weeks post admission)

• LOS (Length Of Stay)

  Length of rehabilitation center stay

  Through study completion, an average of 1 year

Study Arms (2)

Clinical pharmacist intervention group

ACTIVE COMPARATOR

all hip fractured patients admitted to D1 subunit in "Beit rivka" geriatric rehabilitation center. This group will get a clinical pharmacist review of their medication and a pharmaceutical counseling to the medical staff in the first few days of admission (1-5 days post admission)

Other: Pharmaceutical intervention; Other: Rehabilitation

control group

OTHER

The control group will include all hip fractured patients admitted to D2 subunit in "Beit rivka" geriatric rehabilitation center. This group will not receive any pharmacist intervention during their rehabilitation.

Other: Rehabilitation

Interventions

Pharmaceutical intervention OTHER

Pharmaceutical intervention will include a complete medication review by a clinical pharmacist with the following process: medication reconciliation, medication indication and dosage check, medication effectiveness and appropriateness assessment, drug-drug or drug-disease interactions check, medication duplications check, length and cost of treatment evaluation. The pharmacist will use the following tools: Medication appropriateness index (MAI), ACB (Anticholinergic cognitive burden) score and the using the assessment of underutilization (AOU) index.

Clinical pharmacist intervention group

Rehabilitation OTHER

A multidisciplinary team provided medical, nursing, physical, occupational, and social work interventions. Rehabilitation care include: (a) individual physical therapy (PT), 2 to 3 times a week; (b) 30 to 40 min of PT in an adapted fitness room, aerobic training on a treadmill with and without partial weight support and stationary bicycles, 2 to 3 times a week ; (c) 30 to 40 min of virtual reality training by performing challenging functional tasks, 2 times a week and (d) 30 to 45 min of individual occupational therapy (OT), cognitive evaluation and stimulation, safety education, and learning to use assistive devices, 3 times a week.

Clinical pharmacist intervention group; control group

Eligibility Criteria

• Age: 65 Years - 120 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• Elderly patient (65 years of older) who were admitted for rehabilitation after hip fracture at "D" ward in beit rivka post-acute geriatric center.

You may not qualify if:

• Patient that did not complete the rehabilitation period due the following causes: death, acute care hospitalization or severe medical deterioration.
• In the case of D2 sub unit hospitalized patient - any request by the sub unit medical or nursing staff for pharmacist consultation/intervention.

Sponsors & Collaborators

• Rabin Medical Center: lead

Study Sites (1)

Beit Rivka geriatric rehabilitation center

Petah Tikva, Israel

Location

Related Publications (24)

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MeSH Terms

Conditions

Hip Fractures

Interventions

Rehabilitation

Condition Hierarchy (Ancestors)

Femoral Fractures; Fractures, Bone; Wounds and Injuries; Hip Injuries; Leg Injuries

Intervention Hierarchy (Ancestors)

Aftercare; Continuity of Patient Care; Patient Care; Therapeutics; Health Services; Health Care Facilities Workforce and Services

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Head of Rehabilitation Department D, 'Beit Rivka' Geriatric Rehabilitation Center

Study Record Dates

• First Submitted: April 16, 2020
• First Posted: April 24, 2020
• Study Start: March 1, 2020
• Primary Completion: May 1, 2022
• Study Completion: May 1, 2022
• Last Updated: April 11, 2023

Record last verified: 2023-04

Data Sharing

• IPD Sharing: Will not share

Locations

IL (1)