Please select the eligibility criteria that correspond to the clinical trial below.
Title: Information Systems-enabled Outreach Program for Adverse Drug Events
Brief Summary: One of the most common health care interventions in any healthcare setting is a medication prescription. Unfortunately, up to 25% of outpatient prescriptions are associated with adverse drug events (ADEs). ADEs decrease patient health directly and can lead to non-adherence, which in turn has negative consequences.

The investigators recently conducted a pilot project in which the feasibility and potential utility of an information technology enabled outreach program for monitoring patients receiving an outpatient prescription was tested. This intervention involved the use of an interactive voice response system programmed to automatically call ambulatory care patients following a prescription. If the system identified a potential medication problem, a pharmacist was notified who contacted the patient, modified the therapy accordingly, and informed a physician when necessary.

The pilot project included 568 patients with diverse illnesses in two Canadian cities. High levels of patient and provider acceptability of the system were determined from 21 day interviews. The program identified 56 of 125 (45%) ADEs and 10 of 26 (30%) of primary non-compliance events. Very few episodes of ameliorable ADEs were observed.

The investigators feel these results justify a randomized control trial to assess the effectiveness of the intervention for improving patient centered outcomes. Ambulatory care patients receiving incident prescriptions for one of four conditions (hypertension, diabetes mellitus, depression, and anxiety) will be randomized to the intervention or routine care. The investigators expect that the system will reduce the severity and duration of outpatient ADEs and improve adherence to medication care.


Options:
A: Inclusion Criteria:

* The proposed clinical trial will be conducted in volunteers with Chagas disease complicated by heart failure.
* Subjects will include adults, men and women, racial or ethnic minorities.
* Diagnosed by two distinct Chagas serology tests (indirect immunofluorescence and enzyme linked immunosorbent assay

Exclusion Criteria:

* Patients with any of comorbidities that significantly affect the cardiac performance, such as coronary artery disease, moderate or severe heart valvular disease, left ventricular (LV) hypertrophy, congenital heart disease, or that limit their survival, such as malignant tumors and HIV, will be excluded from the study.
* Patients will be also be excluded in case of failure to give informed consent, inability to perform 6 minute- walk test, significant cognitive impairment, or pregnancy.
* Individuals who are participating in others intervention trials will also be excluded.
B: Inclusion Criteria:

* spoken language is French or English
* physician is a user of MOXXI (electronic health record system) and patient has consented to be captured by MOXXI
* receiving a high-risk incident prescription
* medication insurance through Regie de l'Assurances Maladie du Quebec (RAMQ) insurance program

Exclusion Criteria:

* patient not appropriate for inclusion (as determined by prescribing physician)
C: Inclusion Criteria:

* A stroke specialist-determined ischemic stroke or TIA within the past year (including ocular strokes/TIA such as amaurosis fugax).
* Presence of systemic hypertension (average systolic blood pressure over two visits - i.e., SPC visit and study screening visit- exceeding 140 mmHg) OR fasting LDL cholesterol exceeding 2.0 mmol/L OR total: HDL cholesterol ratio exceeding 4.0 at SPC visit.

Exclusion Criteria:

* Neurological event considered to be due to intracranial hemorrhage (e.g., ICH, SAH), or trauma induced, or related to structural heart disease such as ASD/VSD or endocarditis.
* Foreshortened life-expectancy (e.g., active malignancy), hypertensive crisis (clinic systolic BP \> 200 mm Hg), or severe comorbidities.
* Institutionalized in a long-term care facility.
* Cognitive impairment (defined as a score of \> 5 on the Short Portable Mental Status questionnaire).
* Already on maximal therapy for risk factors (on 3 antihypertensive drugs at maximal dose if hypertension is inclusion criterion or on maximal dose statin if hyperlipidemia is inclusion criterion).
D: Inclusion Criteria:

* Patients prescribed medication(s) for at least one of the following conditions: type 2 diabetes, hyperlipidemia

Exclusion Criteria:

* Patients living outside of England
* Patients with no access to a telephone
* Patients under the age of 18
* Patients unable to give written informed consent
* Patients on drugs for dementia
* Patients showing signs of dementia or cognitive impairment in conversation
* Patients with substantial hearing or sight impairment
* Patients whose medications are ordered by a caregiver/family member
* Patients with insufficient English to take part in the telephone intervention
* Patients living with someone already taking part in the study
* Patients newly prescribed a medication for the conditions listed in the inclusion criteria

Answer: B