A Complex Intervention to Prevent Medication-Related Hospital Admissions.

Autor:	Neubert A; Department of Pediatric and Adolescent Medicine, University Hospital Erlangen, Toni I; Department of Pediatric and Adolescent Medicine, University Hospital Erlangen, König J; Institute for Medical Biometry, Epidemiology and Information Technology, University Medicine of the Johannes Gutenberg University of Mainz., Malonga Makosi D; Institute for Medical Biometry, Epidemiology and Information Technology, University Medicine of the Johannes Gutenberg University of Mainz., Mildenberger P; Institute for Medical Biometry, Epidemiology and Information Technology, University Medicine of the Johannes Gutenberg University of Mainz., Romanos M; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Bertsche A; University and University Hospital of Leipzig, Faculty of Medicine, Center for Drug Safety (ZAMS); Clinic for Children and Adolescents, University Medical Center of Rostock, Bertsche T; University and University Hospital of Leipzig, Faculty of Medicine, Center for Drug Safety (ZAMS); University Leipzig, Faculty of Medicine, Institute for Pharmacy, Clinical Pharmacy:, Dahlem P; REGIOMED Hospital Coburg, Department for Pediatric and Adolescent Medicine, Egberts K; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Erdlenbruch B; University Department for Pediatric and Adolescent Medicine, Johannes Wesling Hospital Minden, Ruhr University of Bochum, Fekete S; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Haug U; Leibniz Institute for Prevention Research and Epidemiology – BIPS, Horneff G; Asklepios Children’s Hospital Saint Augustin, Hübler A; Hospital of Chemnitz, Department for Pediatric and Adolescent Medicine, Kiess W; University Hospital of Leipzig, Clinic and Outpatient Clinic for Pediatric and Adolescent Medicine, Neininger MP; University and University Hospital of Leipzig, Faculty of Medicine, Center for Drug Safety (ZAMS), Niehues T; Center for Pediatric and Adolescent Medicine, Helios Hospital Krefeld, Sachs B; Federal Institute for Drugs and Medical Devices (BfArM), Research Department, Schettler KF; St. Marien Children’s Hospital, Landshut, Schreeck F; Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Robert Bosch Society for Medical Research Stuttgart, Steimle T; TK Health Insurance Fund, Hamburg, Wenzl T; University Hospital of Aachen, Department for Pediatric and Adolescent Medicine, Wirth S; Center for Pediatric and Adolescent Medicine, Helios University Hospital Wuppertal, Zepp F; University Medical Center of the Johannes Gutenberg University of Mainz, Clinic and Polyclinic of Pediatrics and Adolescent Medicine, Schwab M; Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Robert Bosch Society for Medical Research Stuttgart; Department of Clinical Pharmacology, University Hospital Tübingen:; Department for Biochemistry and Pharmacy, University of Tübingen, Urschitz MS; Institute for Medical Biometry, Epidemiology and Information Technology, University Medicine of the Johannes Gutenberg University of Mainz., Rascher W; Department of Pediatric and Adolescent Medicine, University Hospital Erlangen
Jazyk:	angličtina
Zdroj:	Deutsches Arzteblatt international [Dtsch Arztebl Int] 2023 Jun 23; Vol. 120 (25), pp. 425-431.
DOI:	10.3238/arztebl.m2023.0123
Abstrakt:	Background: Children are often treated off-label and are at a disadvantage in pharmacotherapy. The aim of this study was to implement and evaluate a quality assurance measure (PaedPharm) for pediatric pharmacotherapy whose purpose is to reduce medication-related hospitalizations among children and adolescents. Methods: PaedPharm consisted of the digital pediatric drug information system PaedAMIS, pediatric pharmaceutical quality circles (PaedZirk), and an adverse drug event (ADE) reporting system (PaedReport). The intervention was implemented in a cluster-randomized trial (DRKS 00013924) in 12 regions, with a pediatric and adolescent medicine clinic in each and a total of 152 surrounding private practitioners, in 6 sequences over 8 quarters. In addition to the proportion of ADE-related hospital admissions (primary endpoint), comprehensive process evaluation included other endpoints such as coverage, user acceptance, and relevance to practice. Results: 41 829 inpatient admissions were recorded, of which 5101 were patients of physicians who participated in our study. 4.1% of admissions were ADE-related under control conditions, and 3.1% under intervention conditions (95% CI: [2.3; 5.9] and [1.8; 4.5], respectively). A model-based comparison yielded an intervention effect of 0.73 (population-based odds ratio; [0.39; 1.37]; p = 0.33). PaedAMIS achieved moderate user acceptance and PaedZirk achieved high user acceptance. Conclusion: The introduction of PaedPharm was associated with a decrease in medication-related hospitalizations that did not reach statistical significance. The process evaluation revealed broad acceptance of the intervention in outpatient pediatrics and adolescent medicine.
Databáze:	MEDLINE
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