Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden.
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
J Clin Pharm Ther. 2020 Oct;45(5):1021-1029. doi: 10.1111/jcpt.13128. Epub 2020 Mar 14.
Drug-related problems (DRPs) are a growing healthcare burden worldwide. In an ongoing cluster-randomized controlled trial in Sweden (MedBridge), comprehensive medication reviews (CMRs) including post-discharge follow-up have been conducted in older hospitalized patients to prevent and solve DRPs. As part of a process evaluation of the MedBridge trial, this study aimed to assess the intervention fidelity and process outcomes of the trial's interventions.
For intervention delivery, the percentage of patients that received intervention components was calculated per study group. Process outcomes, measured in about one-third of all intervention patients, included the following: the number of identified medication discrepancies, DRPs and recommendations to solve DRPs, correction rate of discrepancies, and implementation rate of recommendations.
The MedBridge trial included 2637 patients (mean age: 81 years). The percentage of intervention patients (n = 1745) that received the intended intervention components was 94%-98% during admission, and 40%-81% upon and after discharge. The percentage of control patients (n = 892) that received at least one unintended intervention component was 15%. On average, 1.1 discrepancies and 2.0 DRPs were identified in 652 intervention patients. The correction and implementation rates were 79% and 73%, respectively. Stop medication was the most frequently implemented recommendation (n = 293) and 77% of the patients had at least one corrected discrepancy or implemented recommendation.
The intervention fidelity within the MedBridge trial was high for CMRs during hospital stay and lower for intervention components upon and after discharge. The high prevalence of corrected discrepancies and implemented recommendations may explain potential effects of CMRs in the MedBridge trial.
药物相关问题（DRPs）是全球日益严重的医疗保健负担。在瑞典正在进行的一项集群随机对照试验（MedBridge）中，对住院老年患者进行了包括出院后随访的综合药物评估（CMRs），以预防和解决 DRPs。作为 MedBridge 试验过程评估的一部分，本研究旨在评估试验干预措施的干预保真度和过程结果。
对于干预措施的实施，根据研究组计算接受干预措施的患者比例。过程结果是在大约三分之一的干预患者中进行测量的，包括以下内容：确定的药物差异数量、DRPs 和解决 DRPs 的建议、差异的纠正率以及建议的实施率。
MedBridge 试验共纳入 2637 名患者（平均年龄：81 岁）。在住院期间，接受预期干预措施的干预患者（n=1745）的比例为 94%-98%，出院后为 40%-81%。接受至少一个非预期干预措施的对照组患者（n=892）的比例为 15%。平均而言，在 652 名干预患者中发现了 1.1 个差异和 2.0 个 DRPs。纠正和实施率分别为 79%和 73%。停止用药是最常实施的建议（n=293），77%的患者至少有一个差异得到纠正或建议得到实施。
MedBridge 试验中 CMRs 的干预保真度在住院期间较高，而出院后和出院后的干预措施较低。纠正差异和实施建议的高患病率可能解释了 CMRs 在 MedBridge 试验中的潜在效果。
