PDF(Pubmed)
Abstract：
OBJECTIVE: To evaluate whether a focused, expert medication management intervention is feasible and potentially effective in preventing anticoagulation-related adverse events for patients transitioning from hospital to home.
METHODS: Randomised, parallel design.
METHODS: Medical wards at six hospital sites in southern Ontario, Canada.
METHODS: Adults 18 years of age or older being discharged to home on an oral anticoagulant (OAC) to be taken for at least 4 weeks.
METHODS: Clinical pharmacologist-led intervention, including a detailed discharge medication management plan, a circle of care handover and early postdischarge virtual check-up visits to 1 month with 3-month follow-up. The control group received the usual care.
METHODS: Primary outcomes were study feasibility outcomes (recruitment, retention and cost per patient). Secondary outcomes included adverse anticoagulant safety events composite, quality of transitional care, quality of life, anticoagulant knowledge, satisfaction with care, problems with medications and health resource utilisation.
RESULTS: Extensive periods of restriction of recruitment plus difficulties accessing patients at the time of discharge negatively impacted feasibility, especially cost per patient recruited. Of 845 patients screened, 167 were eligible and 56 were randomised. The mean age (±SD) was 71.2±12.5 years, 42.9% females, with two lost to follow-up. Intervention patients were more likely to rate their ability to manage their OAC as improved (17/27 (63.0%) vs 7/22 (31.8%), OR 3.6 (95% CI 1.1 to 12.0)) and their continuity of care as improved (21/27 (77.8%) vs 2/22 (9.1%), OR 35.0 (95% CI 6.3 to 194.2)). Fewer intervention patients were taking one or more inappropriate medications (7 (22.5%) vs 15 (60%), OR 0.19 (95% CI 0.06 to 0.62)).
CONCLUSIONS: This pilot randomised controlled trial suggests that a transitional care intervention at hospital discharge for older adults taking OACs was well received and potentially effective for some surrogate outcomes, but overly costly to proceed to a definitive large trial.
BACKGROUND: NCT02777047.
METHODS: Randomised, parallel design.
METHODS: Medical wards at six hospital sites in southern Ontario, Canada.
METHODS: Adults 18 years of age or older being discharged to home on an oral anticoagulant (OAC) to be taken for at least 4 weeks.
METHODS: Clinical pharmacologist-led intervention, including a detailed discharge medication management plan, a circle of care handover and early postdischarge virtual check-up visits to 1 month with 3-month follow-up. The control group received the usual care.
METHODS: Primary outcomes were study feasibility outcomes (recruitment, retention and cost per patient). Secondary outcomes included adverse anticoagulant safety events composite, quality of transitional care, quality of life, anticoagulant knowledge, satisfaction with care, problems with medications and health resource utilisation.
RESULTS: Extensive periods of restriction of recruitment plus difficulties accessing patients at the time of discharge negatively impacted feasibility, especially cost per patient recruited. Of 845 patients screened, 167 were eligible and 56 were randomised. The mean age (±SD) was 71.2±12.5 years, 42.9% females, with two lost to follow-up. Intervention patients were more likely to rate their ability to manage their OAC as improved (17/27 (63.0%) vs 7/22 (31.8%), OR 3.6 (95% CI 1.1 to 12.0)) and their continuity of care as improved (21/27 (77.8%) vs 2/22 (9.1%), OR 35.0 (95% CI 6.3 to 194.2)). Fewer intervention patients were taking one or more inappropriate medications (7 (22.5%) vs 15 (60%), OR 0.19 (95% CI 0.06 to 0.62)).
CONCLUSIONS: This pilot randomised controlled trial suggests that a transitional care intervention at hospital discharge for older adults taking OACs was well received and potentially effective for some surrogate outcomes, but overly costly to proceed to a definitive large trial.
BACKGROUND: NCT02777047.
摘要：
目的：评估是否有重点，对于从医院转院到家庭的患者,专家级药物管理干预在预防抗凝相关不良事件方面是可行的,并且可能有效.
方法：随机，并行设计。
方法：安大略省南部六个医院的医疗病房，加拿大。
方法：18岁或以上的成年人出院回家，服用口服抗凝剂（OAC）至少4周。
方法：临床药理学家主导的干预，包括详细的出院用药管理计划,1个月的护理交接和出院后早期虚拟检查访问，并进行3个月的随访。对照组接受常规护理。
方法：主要结果是研究可行性结果(招募，保留率和每位患者的费用)。次要结局包括不良抗凝安全事件复合，过渡期护理的质量，生活质量,抗凝知识,满意的护理，药物和卫生资源利用方面的问题。
结果：广泛的招募限制期加上出院时难以进入患者，对可行性产生负面影响，尤其是招募的每位患者的费用。在接受筛查的845名患者中，167人符合条件，56人随机分组。平均年龄（±SD）为71.2±12.5岁，42.9%女性，有两个失去了后续。干预患者更有可能将他们管理OAC的能力评价为改善(17/27(63.0%)vs7/22(31.8%),OR3.6（95％CI1.1至12.0））及其护理连续性得到改善（21/27（77.8％）vs2/22（9.1％），OR35.0（95%CI6.3至194.2））。更少的干预患者服用一种或多种不适当的药物（7（22.5％）vs15（60％），OR0.19（95%CI0.06至0.62））。
结论：这项试点随机对照试验表明，对服用OAC的老年人进行出院时的过渡性护理干预广受好评，并可能对某些替代结果有效。但进行明确的大型试验成本过高。
背景：NCT02777047。
方法：随机，并行设计。
方法：安大略省南部六个医院的医疗病房，加拿大。
方法：18岁或以上的成年人出院回家，服用口服抗凝剂（OAC）至少4周。
方法：临床药理学家主导的干预，包括详细的出院用药管理计划,1个月的护理交接和出院后早期虚拟检查访问，并进行3个月的随访。对照组接受常规护理。
方法：主要结果是研究可行性结果(招募，保留率和每位患者的费用)。次要结局包括不良抗凝安全事件复合，过渡期护理的质量，生活质量,抗凝知识,满意的护理，药物和卫生资源利用方面的问题。
结果：广泛的招募限制期加上出院时难以进入患者，对可行性产生负面影响，尤其是招募的每位患者的费用。在接受筛查的845名患者中，167人符合条件，56人随机分组。平均年龄（±SD）为71.2±12.5岁，42.9%女性，有两个失去了后续。干预患者更有可能将他们管理OAC的能力评价为改善(17/27(63.0%)vs7/22(31.8%),OR3.6（95％CI1.1至12.0））及其护理连续性得到改善（21/27（77.8％）vs2/22（9.1％），OR35.0（95%CI6.3至194.2））。更少的干预患者服用一种或多种不适当的药物（7（22.5％）vs15（60％），OR0.19（95%CI0.06至0.62））。
结论：这项试点随机对照试验表明，对服用OAC的老年人进行出院时的过渡性护理干预广受好评，并可能对某些替代结果有效。但进行明确的大型试验成本过高。
背景：NCT02777047。
