Optimizing drug therapy in high risk older patients

The global population is ageing. This evolution prompts new needs for health care that urgently need to be addressed. Briefly, older adults use more health care resources overall and are more regularly admitted to the hospital. Those hospital admissions represent a substantial portion of national health care budgets. Polypharmacy and potentially inappropriate medications have been shown to be important risk factors associated with such unplanned admissions. Importantly, up to 20% of hospital admissions in older adults might be related to medication harm. Furthermore, these admissions have been considered to be largely preventable. Strategies are hence needed to reduce avoidable harm, including unplanned admission, in susceptible older adults. In that regard, multiple strategies have already been investigated, e.g. to reduce the number of hospital admissions, to improve clinical status and by doing so, to reduce avoidable harm and costs. Ward-based clinical pharmacists were regularly involved in such clinical studies. Their activities might comprise screening for, identifying, and solving drug-related problems, which could potentially lead to actual harm, such as unplanned readmissions. Clinical pharmacists commonly performed these tasks in a multidisciplinary team setting in at risk patient populations, such as acutely admitted older adults. Resources for ward-based clinical pharmacists are limited however in Belgium. It is hence important to identify patients who might derive the largest benefit of such services. The overall aim of this PhD project is to reduce unplanned readmissions in high risk inpatients. First, we aim to determine which patient profiles suffer from an increased risk for incident hospital admissions and hospital readmissions. Second, we will investigate in a large randomized clinical trial (RCT) the impact of a multifaceted clinical pharmacy intervention for such high risk patients admitted to the acute geriatric wards of the University Hospitals Leuven. In this RCT we seek to optimize drug therapy and promote transitional care from hospital to primary care. The primary objective herein is to reduce all-cause unplanned hospital visits in geriatric inpatients.