Optimizing medical-pharmaceutical care to reduce hospital readmissions in older adults

Inappropriate prescribing in older adults is regarded as a major and urgent healthcare problem. It has been associated with a substantial burden of iatrogenic morbidity, including adverse drug events. In particular older adults are regularly admitted to the hospital due to a multitude of drug-related problems, including the underuse of indicated therapies. A large part of these admissions is considered to be avoidable. After hospital discharge, older adults are equally at increased risk for all-cause as well as drug-related hospital readmissions. Contemporary, robust trial data on best practices to manage iatrogenic drug-related morbidity are mostly non-existent. This lack of evidence is even more apparent in geriatric inpatients, who suffer from a very high risk of drug-related problems and readmissions. Hence, the need to improve pharmacotherapy while ensuring appropriate transitional care should be considered the most pressing issue in this geriatric inpatient population. This PhD project will focus on medical-pharmaceutical care to reduce hospital readmissions in older adults. We aim to develop an intervention to reduce hospital admissions which will be tested and validated in a large randomized-controlled trial (RCT). In this RCT we will aim to improve the pharmacotherapy trajectory for inpatients admitted to acute geriatric care wards. The intervention will consist of a multifaceted pharmacist intervention, comprising a medication review, patient education and a transitional care step. The primary outcome will be the time to an unplanned hospital visit. As part of this RCT, a telepharmacology center will be developed and established to further improve transmural care and ease communication between healthcare professionals both in primary and secondary care.