Protocol for a Prospective (P) study to develop a model to stratify the risk (RI) of medication (M) related harm in hospitalized elderly (E) patients in the UK (The PRIME study)

Journal article (2016)

Authors

Jennifer M. Stevenson Guy’s and St. Thomas’ NHS Foundation Trust
J.M. Stevenson Guy’s and St. Thomas’ NHS Foundation Trust
Nikesh Parekh Brighton and Sussex Medical School
Chakravarthi Rajkumar Brighton and Sussex Medical School
Khalid Ali Brighton and Sussex Medical School
Jean Timeyin Brighton and Sussex University Hospitals’ Trust
Stephen Bremner Brighton and Sussex Medical School
Tischa van der Cammen Applied Ergonomics and Design - IDE
TJM van der Cammen Applied Ergonomics and Design - IDE
T.J.M. van der Cammen Applied Ergonomics and Design - IDE
Tischa J.M. van der Cammen Applied Ergonomics and Design - IDE
Jane Allen Brighton and Sussex University Hospitals’ Trust
Rebekah Schiff Guy’s and St. Thomas’ NHS Foundation Trust
Jatinder Harchowal The Royal Marsden NHS Foundation Trust
J. Graham Davies King’s College London
Research Group
Applied Ergonomics and Design (IDE) (TU Delft)
Copyright: © 2016 Jennifer Stevenson, Nikesh Parekh, Khalid Ali, Jean Timeyin, Stephen Bremner, T.J.M. van der Cammen, Jane Allen, Rebekah Schiff, Jatinder Harchowal, Graham Davies, Chakravarthi Rajkumar
DOI: https://doi.org/10.1186%2Fs12877-016-0191-8
More Info
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Published Date

2016

Language

English

Faculty

Industrial Design Engineering

Department

Human-Centered Design

Research Group

Applied Ergonomics and Design

Abstract

Background: Medication related harm (MRH) is a common cause of morbidity and hospital admission in the elderly, and has significant cost implications for both primary and secondary healthcare resources. The development of risk prediction models has become an increasingly common phenomenon in medicine and can be useful to guide objective clinical decision making, resource allocation and intervention. There are no risk prediction models that are widely used in clinical practice to identify elderly patients at high risk of MRH following hospital
discharge. The aim of this study is to develop a risk prediction model (RPM) to identify elderly patients at high risk of MRH upon discharge from hospital, and to compare this with routine clinical judgment.

Methods/Design: This is a multi-centre, prospective observational study following a cohort of patients for 8 weeks after hospital discharge. Data collection including patient characteristics, medication use, social factors and frailty will take place prior to patient discharge and then the patient will be followed up in the community over the next 8 weeks to determine if they have experienced MRH. Research pharmacists will determine whether patients have
experienced MRH by prospectively reviewing records for unplanned emergency department attendance, hospital readmission and GP consultation related to MRH. Research pharmacists will also telephone patients directly to
determine self-reported MRH, which patients may not have sought further medical attention for. The data collected will inform the development of a RPM which will be externally validated in a follow-up study.

Discussion: There are no RPMs that are used in clinical practice to help stratify elderly patients at high risk of MRH in the community following hospital discharge, despite this being a significant public health problem. This study plans to develop a clinically useful RPM that is better than routine clinical judgment. As this is a multi-centre study
involving clinical settings that serve elderly people of heterogeneous sociodemographic background, it is anticipated that this RPM will be generalizable.