Effect of integrated medicines management on the quality of drug treatment in hospitalised multimorbid patients — a secondary endpoint analysis of a randomised controlled trial

Abstract

Abstract Objectives To investigate the effect of integrated medicines management provided to hospitalised multimorbid patients on the quality of drug treatment at discharge measured as the mean number of potential prescribing omissions and potentially inappropriate medicines. Methods Multimorbid patients ≥18 years, using a minimum of four regular drugs from a minimum of two therapeutic drug classes, were recruited from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016 and randomly assigned, 1:1, to the intervention or control group. Intervention patients received integrated medicines management throughout the hospital stay. Control patients received standard care. This paper reports the results of a pre-specified secondary endpoint analysis of a randomised controlled trial; the difference between the intervention and control group at discharge in the mean number of potential prescribing omissions and potentially inappropriate medicines, measured with START-2 and STOPP-2 criteria, respectively. The difference between the groups was calculated using rank analysis. Key findings In total, 386 patients were analysed. Integrated medicines management reduced the mean number of potential prescribing omissions at discharge, compared to the control group, 1.34 versus 1.57, respectively (mean difference 0.23, 95% CI 0.07–0.38, P = 0.005, adjusted for values at admission). There was no difference in the mean number of potentially inappropriate medicines at discharge (1.84 versus 1.88, respectively; mean difference 0.03, 95% CI −0.18 to 0.25, P = 0.762, adjusted for values at admission). Conclusions Integrated medicines management delivered to multimorbid patients during a hospital stay led to an improvement in undertreatment. No effect on deprescribing of inappropriate treatment was seen.