Pharmacist participation in hospital ward teams and hospital readmission rates among people with dementia: a randomized controlled trial.
PURPOSE
To assess whether comprehensive medication reviews conducted by clinical pharmacists as part of a healthcare team reduce drug-related hospital readmission rates among people with dementia or cognitive impairment.


METHODS
This randomized controlled trial was carried out between January 9, 2012, and December 2, 2014. Patients aged ≥65 years with dementia or cognitive impairment admitted to three wards at two hospitals located in Northern Sweden were included.


RESULTS
Of the 473 deemed eligible for participation, 230 were randomized to intervention and 230 to control group by block randomization. The primary outcome, risk of drug-related hospital readmissions, was assessed at 180 days of follow-up by intention-to-treat analysis. During the 180 days of follow-up, 18.9% (40/212) of patients in the intervention group and 23.0% (50/217) of those in the control group were readmitted for drug-related reasons (HR = 0.80, 95% CI = 0.53-1.21, p = 0.28, univariable Cox regression). Heart failure was significantly more common in the intervention group. After adjustment for heart failure as a potential confounder and an interaction term, multiple Cox regression analysis indicated that pharmacist participation significantly reduced the risk of drug-related readmissions (HR = 0.49, 95% CI = 0.27-0.90, p = 0.02). A post-hoc analysis showed a significantly reduced risk of 30-day readmissions due to drug-related problems in the total sample (without adjustment for heart failure).


CONCLUSION
Participation of clinical pharmacists in healthcare team conducting comprehensive medication reviews did not significantly reduce the risk of drug-related readmissions in patients with dementia or cognitive impairment; however, post-hoc and subgroup analyses indicated significant effects favoring the intervention. More research is needed.


TRIAL REGISTRATION
Clinical trials NCT01504672.
['Gustafsson|Maria|M|', 'Sjölander|Maria|M|', 'Pfister|Bettina|B|', 'Jonsson|Jeanette|J|', 'Schneede|Jörn|J|', 'Lövheim|Hugo|H|']
D000368:Aged D000369:Aged, 80 and over D060825:Cognitive Dysfunction D003704:Dementia D005260:Female D006801:Humans D053208:Kaplan-Meier Estimate D008297:Male D059065:Medication Reconciliation D010348:Patient Care Team D010359:Patient Readmission D010595:Pharmacists D010607:Pharmacy Service, Hospital
Dementia Medication reviews Clinical pharmacists Drug-related readmissions Old people