title: Pharmacist participation in hospital ward teams and hospital readmission rates among people with dementia: a randomized controlled trial.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Clinical trials NCT01504672.
authors.affiliation: Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 85, Umeå, Sweden. maria.gustafsson@umu.se.|Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden. maria.gustafsson@umu.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Gustafsson
authors.affiliation: Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 85, Umeå, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Sjölander
authors.affiliation: Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 85, Umeå, Sweden.
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfister
authors.affiliation: Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 85, Umeå, Sweden.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Jonsson
authors.affiliation: Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 85, Umeå, Sweden.
authors.forename: Jörn
authors.initials: J
authors.lastname: Schneede
authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: Hugo
authors.initials: H
authors.lastname: Lövheim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000188:drug therapy*; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D059065:Medication Reconciliation; D010348:Patient Care Team; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010595:Pharmacists; D010607:Pharmacy Service, Hospital
keywords: Clinical pharmacists; Dementia; Drug-related readmissions; Medication reviews; Old people