Control in the Hospital by Extensive Clinical rules for Unplanned hospitalizations in older Patients (CHECkUP): study design of a multicentre randomized study

Aimée E.M.J.H. Linkens*, Vanja Milosevic, Noémi van Nie, Anne Zwietering, Peter W. de Leeuw, Marjan van den Akker, Jos M.G.A. Schols, Silvia M.A.A. Evers, Carlota Mestres Gonzalvo, Bjorn Winkens, Bob P.A. van de Loo, Louis de Wolf, Lucretia Peeters, Monique de Ree, Bart Spaetgens, Kim P.G.M. Hurkens, Hugo M. van der Kuy

*Corresponding author for this work

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Abstract

Background: Due to ageing of the population the incidence of multimorbidity and polypharmacy is rising. Polypharmacy is a risk factor for medication-related (re)admission and therefore places a significant burden on the healthcare system. The reported incidence of medication-related (re)admissions varies widely due to the lack of a clear definition. Some medications are known to increase the risk for medication-related admission and are therefore published in the triggerlist of the Dutch guideline for Polypharmacy in older patients. Different interventions to support medication optimization have been studied to reduce medication-related (re)admissions. However, the optimal template of medication optimization is still unknown, which contributes to the large heterogeneity of their effect on hospital readmissions. Therefore, we implemented a clinical decision support system (CDSS) to optimize medication lists and investigate whether continuous use of a CDSS reduces the number of hospital readmissions in older patients, who previously have had an unplanned probably medication-related hospitalization. Methods: The CHECkUP study is a multicentre randomized study in older (≥60 years) patients with an unplanned hospitalization, polypharmacy (≥5 medications) and using at least two medications from the triggerlist, from Zuyderland Medical Centre and Maastricht University Medical Centre+ in the Netherlands. Patients will be randomized. The intervention consists of continuous (weekly) use of a CDSS, which generates a Medication Optimization Profile, which will be sent to the patient’s general practitioner and pharmacist. The control group will receive standard care. The primary outcome is hospital readmission within 1 year after study inclusion. Secondary outcomes are one-year mortality, number of emergency department visits, nursing home admissions, time to hospital readmissions and we will evaluate the quality of life and socio-economic status. Discussion: This study is expected to add evidence on the knowledge of medication optimization and whether use of a continuous CDSS ameliorates the risk of adverse outcomes in older patients, already at an increased risk of medication-related (re)admission. To our knowledge, this is the first large study, providing one-year follow-up data and reporting not only on quality of care indicators, but also on quality-of-life. Trial registration: The trial was registered in the Netherlands Trial Register on October 14, 2018, identifier: NL7449 (NTR7691). https://www.trialregister.nl/trial/7449.

Original languageEnglish
Article number36
JournalBMC Geriatrics
Volume22
Issue number1
DOIs
Publication statusPublished - 10 Jan 2022

Bibliographical note

Funding Information:
The CHECkUP is supported by a grant from the Netherlands Organization for Health Research and Development (ZonMw), grant number: 848016012. The funding body has no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2022, The Author(s).

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