Evidence map›Paper›PMID 41444867›Full record

ArticleBMC geriatrics2025

Less Is More: Optimized pharmacotherapy with improved coNtinuity of CarE in hospitaLized oLder peOple (LIMONCELLO): study protocol of a cluster randomized controlled trial.

Sjacky Cooijmans, Eline M C Engelen, Stéphanie C M Wuyts, Cornelis Kramers, Michiel A van Agtmael, Patricia M L A van den Bemt, Marcel L Bouvy, Hayat Amouch, Reshma S Autar, Guillemette E Benoist and 29 more

Registry-linked trialAbstract readClinical Trial Protocol
In one paragraph

Article in BMC geriatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05899114 (Less Is More), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05899114 nacompletednot on this map

Less Is More: Optimized Pharmacotherapy With Improved coNtinuity of CarE in hospitaLized oLder peOple

TypeinterventionalSponsorRadboud University Medical CenterRan2023 to 2026Enrolled1,241ConditionsPolypharmacy, Medication ReviewArmsTransitional Multidisciplinary Pharmacotherapeutic Care
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

39 authors.

Sjacky CooijmansDepartment of Pharmacy, Pharmacology and Toxicology, Radboud University Medical Center, Mailbox 9101, Geert Grooteplein-Zuid 10, (Route Number 456), 6500 HB, Nijmegen, The Netherlands. sjacky.cooijmans@radboudumc.nl.
Eline M C EngelenDepartment of Internal Medicine, Amsterdam University Medical Center - location VUmc, Amsterdam, The Netherlands.
Stéphanie C M WuytsResearch Centre for Digital Medicine, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
Cornelis KramersDepartment of Pharmacy, Pharmacology and Toxicology, Radboud University Medical Center, Mailbox 9101, Geert Grooteplein-Zuid 10, (Route Number 456), 6500 HB, Nijmegen, The Netherlands.
Michiel A van AgtmaelDepartment of Internal Medicine, Amsterdam University Medical Center - location VUmc, Amsterdam, The Netherlands.
Patricia M L A van den BemtDepartment of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands.
Marcel L BouvyDivision of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Hayat AmouchDepartment of Clinical Pharmacy, Amphia Ziekenhuis, Breda, The Netherlands.
Reshma S AutarDepartment of Internal Medicine, Amsterdam University Medical Center - location VUmc, Amsterdam, The Netherlands.
Guillemette E BenoistDepartment of Pharmacy, Deventer Ziekenhuis, Deventer, The Netherlands.
Inge R F van Berlo-van de LaarDepartment of Pharmacy, Deventer Ziekenhuis, Deventer, The Netherlands.
Judith Y M N Derijks-EngwegenDepartment of Pharmacy, Pharmacology and Toxicology, Radboud University Medical Center, Mailbox 9101, Geert Grooteplein-Zuid 10, (Route Number 456), 6500 HB, Nijmegen, The Netherlands.
Geke van den ElsenDepartment of Clinical Geriatrics, Ziekenhuisgroep Twente, Almelo, The Netherlands.
Frouke M EngelaerDepartment of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Kim B Gombert-HandokoDepartment of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands.
David R M JansenDepartment of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands.
Marieke H M KerskesDepartment of Clinical Pharmacy, Catharina Ziekenhuis, Eindhoven, The Netherlands.
Willemien J Kruik-KollöffelDepartment of Clinical Pharmacy, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands.
Marianne A KuijvenhovenPharmacy & Clinical Pharmacology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Hugo M van der KuyDepartment of Hospital Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Geert LabotsDepartment of Internal Medicine, HagaZiekenhuis, Den Haag, The Netherlands.
Eveline P van PoelgeestDepartment of Internal Medicine, Geriatrics, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Roos SablerollesDepartment of Hospital Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Bastiaan T G SalleveltClinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Feikje van StiphoutDepartment of Geriatric Medicine, Meander Medical Center, Amersfoort, The Netherlands.
Bert N StormDepartment of Hospital Pharmacy, HagaZiekenhuis, Den Haag, The Netherlands.
Margot TaksDepartment of Clinical Pharmacy, Amphia Ziekenhuis, Breda, The Netherlands.
Patty J I TeeuwisseDepartment of Pharmacy and Clinical Pharmacology, Amsterdam University Medical Center Location AMC, Amsterdam, The Netherlands.
Jonne UiterwijkDepartment of Clinical Pharmacy, Catharina Ziekenhuis, Eindhoven, The Netherlands.
Ariël VondelingDepartment of Clinical Geriatrics, Diakonessenhuis, Utrecht, Zeist and Doorn, The Netherlands.
Merijn de VriesDepartment of Clinical Pharmacy, Meander Medical Center, Amersfoort, The Netherlands.
Elsbeth WesselinkDepartment of Clinical Pharmacy, Zaans Medical Center, Zaandam, The Netherlands.
Nikki M L WiggersDepartment of Clinical Pharmacy, Zaans Medical Center, Zaandam, The Netherlands.
Hugo A J M de WitDepartment of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
Henk J SchersDepartment of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Eddy M M AdangDepartment for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
Madelon van WelyCenter for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Noortje van HerwaardenDepartment of Pharmacy, Pharmacology and Toxicology, Radboud University Medical Center, Mailbox 9101, Geert Grooteplein-Zuid 10, (Route Number 456), 6500 HB, Nijmegen, The Netherlands.
Wilma KnolDepartment of Geriatric Medicine and Expertise Centre Pharmacotherapy in Older People, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Funding

Dutch Organization for Health Research and Development (ZonMw) 10330032010002
6 · The paper itself

Abstract

backgroundPolypharmacy is associated with negative health outcomes including drug-related hospital admissions, particularly in older patients. Approximately half of drug-related (re)admissions are potentially preventable, and are therefore a target for healthcare interventions. Several studies have investigated the effects of in-hospital medication reviews on clinically relevant outcome measures, such as drug-related readmissions (DRAs). The identified factors for success of the intervention were multicomponent interventions, multidisciplinary approaches, attention to transitional care and the selection of high-risk patients. In the present study, the impact of transitional multidisciplinary pharmacotherapeutic care (TMPC) on DRAs in a high-risk population is assessed.

methodsLess Is More: Optimized pharmacotherapy with improved coNtinuity of CarE in hospitaLized oLder peOple (LIMONCELLO) is a cluster randomized controlled trial. A cluster is defined at the hospital level, and each cluster is randomly allocated (1:1) to the intervention or control group stratified by university or general hospitals. Patients aged 70 years and older with polypharmacy, a current non-elective hospital admission, completed medication reconciliation, and an increased risk of a DRA, as determined by the use of a DRA prediction model, are selected. TMPC consists of four elements: a pharmacotherapeutic analysis, a transitional multidisciplinary discussion, a pharmacotherapeutic care interview including shared decision-making with the patient, and a discharge letter with the pharmacotherapeutic plan sent to the general practitioner and community pharmacist. The comparator is usual care provided in the participating control hospitals. The primary outcome is the proportion of patients with DRA in the first 30 days after discharge. The secondary outcomes include cost-effectiveness, quality of life, and mortality. DISCUSSION: The novelty of this study lies in the selection of a patient group expected to be at high risk for DRAs, on the basis of an evidence-based prediction model, as well as in the combination of components used in the intervention. By selecting high-risk patients and applying a multicomponent approach, this study is expected to increase current knowledge on the effects of TMPC on clinically relevant outcomes and cost-effectiveness in hospitalized older patients.

trial registrationClinicaltrials.gov: NCT05899114, prospective submission, registration June 02 2023 (first inclusion June 5 2023).

Indexed as

Continuity of Patient CareHospitalizationPolypharmacyAgedAged, 80 and overFemaleHumansMaleMedication ReconciliationPatient ReadmissionRandomized Controlled Trials as TopicCluster randomized controlled trialDrug-related readmissionsInappropriate prescribingMedication reviewOlder personsPolypharmacy

Identifiers

PMID41444867
PMCPMC12729224

What Socratic holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.