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Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial.

Author(s)Crotty, Maria; Rowett, Debra; Spurling, Lisa; Giles, Lynne C; Phillips, Paddy A

Source The American journal of geriatric pharmacotherapy; Dec 2004; vol. 2 (no. 4); p. 257-264

Publication Date Dec 2004

ISSN 1543-5946

Publication Type(s) Research Support, Non-u.s. Gov't Randomized Controlled Trial Clinical Trial Multicenter Study Journal Article

Database Medline

Poorly executed transfers of older patients from hospitals to long-term care facilities carry the risk of fragmentation of care, poor clinical outcomes, inappropriate use of emergency department services, and hospital readmission. This study was conducted to assess the impact of adding a pharmacist transition coordinator on evidence-based medication management and health outcomes in older adults undergoing first-time transfer from a hospital to a long-term care facility. This randomized, single-blind, controlled trial enrolled hospitalized older adults awaiting transfer to a long-term residential care facility for the first time. Patients were randomized either to receive the services of the pharmacist transition coordinator (intervention group) or to undergo the usual hospital discharge process (control group). The intervention included medication-management transfer summaries from hospitals, timely coordinated medication reviews by accredited community pharmacists, and case conferences with physicians and pharmacists. The primary outcome was the quality of prescribing, measured using the Medication Appropriateness Index (MAI). Secondary outcomes were emergency department visits, hospital readmissions, adverse drug events, falls, worsening mobility, worsening behaviors, increased confusion, and worsening pain. One hundred ten older adults (67 women, 43 men; mean [SD] age, 82.7 [6.4] years) were recruited from 3 metropolitan hospitals and assigned to 85 metropolitan long-term care facilities. Fifty-six patients were randomized to the intervention group and 54 to the control group; 44 patients in each group were evaluable at 8-week follow-up. There were no significant differences in baseline characteristics between treatment groups, with the exception of the number of medications discontinued during hospitalization: a mean of 1.1 more drugs was discontinued in the control group compared with the intervention group (P = 0.011). The majority of patients (35 [62.5%] in the intervention group, 41 [76.0%] in the control group) changed physicians as part of the transition to a long-term care facility. At 8-week follow-up, there was no change in MAI from baseline in the intervention group, whereas it had worsened in the control group (mean [95% CI], 2.5 [1.4-3.7] vs 6.5 [3.9-9.1], respectively; P = 0.007). Patients who received the intervention and were alive at follow-up exhibited a significant protective effect of the intervention against worsening pain (relative risk ratio [95% CI], 0.55 [0.32-0.94]; P = 0.023) and hospital usage (i.e., the combination of emergency department visits and hospital readmissions) (0.38 [0.15-0.99]; P = 0.035), but did not differ from control patients in terms of adverse drug events (1.05 [0.66-1.68]), falls (1.19 [0.71-1.99]), worsening mobility (0.39 [0.13-1.15]), worsening behaviors (0.52 [0.25-1.10]), or increased confusion (0.59 [0.28-1.22]). When data for patients who had died were included, the intervention had no effect on hospital usage in all patients (0.58 [0.28-1.21]). Older people transferring from hospital to a long-term care facility are vulnerable to fragmentation of care and adverse events. In this study, use of a pharmacist transition coordinator improved aspects of inappropriate use of medicines across health sectors.

 

Or this

 

Corrected arm muscle area: an independent predictor of long-term mortality in community-dwelling older adults?

Author(s)Miller, Michelle D; Crotty, Maria; Giles, Lynne C; Bannerman, Elaine; Whitehead, Craiget al.Miller, Michelle D; Crotty, Maria; Giles, Lynne C; Bannerman, Elaine; Whitehead, Craig; Cobiac, Lynne; Daniels, Lynne A; Andrews, Gary

Source Journal of the American Geriatrics Society; Jul 2002; vol. 50 (no. 7); p. 1272-1277

Publication Date Jul 2002

Older people are at risk of undernutrition because of a number of physiological conditions and lifestyle factors. The purpose of this study was to explore the predictive relationship of corrected arm muscle area (CAMA) with 8-year mortality in a representative sample of older Australians. Prospective cohort study: The Australian Longitudinal Study of Ageing. Community. One thousand three hundred ninety-six participants aged 70 and older. Trained observers measured baseline weight, height, mid upper arm circumference, and triceps skinfold thickness using standard techniques. Body mass index (BMI) and CAMA were calculated. Baseline BMI and CAMA measurements were categorized according to cutoff values proposed by Garrow et al. and Friedman et al., respectively. Subsequent analyses were undertaken using Cox proportional hazards regression. After adjustment for potential confounders (baseline age, gender, marital status, smoking, self-rated health, ability to conduct activities of daily living, comorbidity, cognition performance, and presence of depression), those older Australians with a low

 

Available in full text from National Library of Medicine

Available in full text from National Library of Medicine

 

 

 

 

 

Is this the one Dorothy?

 

https://hdas.nice.org.uk/strategy/86660/5#8

 

best

Barbara

 

 

 

Hello

One of our readers has sent us this email

I really need your help, I’m desperately trying to find a journal article that I’m citing in an essay which ECIST make reference to all the time.

Its by Giles et al (2004) the phrases that is constantly cited is ‘10 days in hospital leads to the equivalent of an additional 10 years ageing in the muscle of people aged over 80’.

 

It seems that this piece of “knowledge” is cited very frequently but is hard to trace.  Indeed, I spent about 20 minutes last night looking, and the best I could get is

The article is at http://biomedgerontology.oxfordjournals.org/content/59/7/M755.long

 

Gerontol A Biol Sci Med Sci. 2004 Jul;59(7):755-61.

The deleterious effects of bed rest among community-living older persons.

Gill TM¹, Allore H, Guo Z.

 

This doesn’t quite work – it’s Gill instead of Giles, and the reader says it is very related but not the right article.  She is really interested in hospitalisation and its effects.

Please does anyone have any knowledge of the source of this quotation?

 

I’m about to leave the library to attend a funeral, but I’ll be back at lunchtime.

Kind regards

Dorothy

 

 

 

Dorothy Halfhide

Laxton Library

Dept 401A, Learning Centre

Peterborough City Hospital

Edith Cavell Campus

Bretton Gate

PE3 9GZ

 

01733 678081

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