Cam Henrik, Franzon Kristin, Östman Victoria, Kälvemark Sporrong Sofia, Kempen Thomas Gerardus Hendrik, Nielsen Elisabet I, Lindner Karl-Johan, Ekelo Beatrice, Bernsten Cecilia, Ehlin Ulf, Lindmark Stina, Hadziosmanovic Nermin, Gillespie Ulrika
Department of Pharmacy, Uppsala University, Uppsala, Sweden
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
BMJ Open. 2025 May 2;15(5):e099547. doi: 10.1136/bmjopen-2025-099547.
Care transitions, particularly hospital discharge, present significant risks to patient safety. Deficient medication-related discharge communication is a major contributor, posing substantial risk of harm to older patients. This protocol outlines the Improved Medication communication and Patient involvement At Care Transitions (IMPACT-care) intervention study, designed to evaluate the effects of a multifaceted intervention for older hospitalised patients on medication-related discharge communication compared with usual hospital care.
A pre-post intervention study will be conducted in two surgical and one geriatric ward of a university hospital in Sweden. The study will begin with a control period delivering usual care, followed by a training period and then an intervention period. The intervention comprises four components performed by clinical pharmacists: (1) information package provided to patients and/or informal caregivers, (2) preparation of medication-related discharge documentation, (3) facilitation of discharge communication and (4) follow-up call to patients or their informal caregiver. Eligible participants are aged ≥65 years, manage their own medications independently or with informal caregiver support, and are admitted to the study wards. Each study period (control and intervention) will last until 115 patients have been included. The primary outcome is the quality of medication-related discharge documentation, assessed using the Complete Medication Documentation at Discharge Measure (CMDD-M). Secondary outcomes include patients' perceptions of knowledge and involvement in discharge medication communication, and their sense of security in managing medication post-discharge; adherence to medication changes from hospitalisation that persist after discharge; and unplanned healthcare visits following discharge. A process evaluation is planned to explore how the intervention was implemented. Patient inclusion began in September 2024.
The study protocol has been approved by the Swedish Ethical Review Authority (registration no.: 2023-03518-01 and 2024-04079-02). Results will be published in open-access international peer-reviewed journals, and presented at national and international conferences.
NCT06610214.
护理转接，尤其是医院出院环节，对患者安全构成重大风险。与药物相关的出院沟通不足是一个主要因素，对老年患者造成严重伤害风险。本方案概述了改善护理转接时药物沟通与患者参与度（IMPACT-care）干预研究，旨在评估针对老年住院患者的多方面干预措施与常规医院护理相比，对与药物相关的出院沟通的影响。
将在瑞典一家大学医院的两个外科病房和一个老年病房进行干预前后研究。研究将从提供常规护理的对照期开始，接着是培训期，然后是干预期。干预包括临床药师执行的四个组成部分：（1）向患者和/或非正式护理人员提供信息包，（2）准备与药物相关的出院文件，（3）促进出院沟通，（4）给患者或其非正式护理人员打电话随访。符合条件的参与者年龄≥65岁，独立或在非正式护理人员支持下管理自己的药物，且被收治到研究病房。每个研究阶段（对照和干预）将持续到纳入115名患者。主要结局是与药物相关的出院文件质量，使用出院时完整药物文件测量法（CMDD-M）进行评估。次要结局包括患者对出院药物沟通中的知识和参与度的认知，以及他们出院后管理药物的安全感；出院后持续存在的因住院导致的药物变化的依从性；以及出院后的非计划医疗就诊。计划进行过程评估以探讨干预措施的实施方式。患者纳入工作于2024年9月开始。
该研究方案已获得瑞典伦理审查局批准（注册号：2023-03518-01和2024-04079-02）。研究结果将发表在开放获取的国际同行评审期刊上，并在国内和国际会议上展示。
NCT06610214。
