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:

* Nursing homes within pre-determined regions of Ontario that expressed an interest in the full intervention (the regions, or hubs, contain a wide variety of nursing home types within a reasonable travel distance \[i.e., \<100 km\])
* Nursing homes within the hubs in which the medical and administrative leads agree to and support the project

Exclusion criteria:

* Nursing homes with a previous or ongoing involvement in externally supported quality improvement initiatives focusing on antipsychotic medications
* Nursing homes without any prescribers caring for at least 10 residents routinely
* Nursing homes with fewer than 30 residents
B: Inclusion Criteria:

* 18-years old or older;
* have a diagnosis of diabetes mellitus either by ICD-billing codes or indicative medications;
* are prescribed at least (3) chronic condition medications according to the EHR medication list;
* are English or Spanish-speaking;
* have no imminent intention to move or change clinics within the next year;
* score 4 or higher on the six-question screener based on the Mini-Mental Status Exam;
* are primarily responsible for administering their own medications;
* prescribed a new chronic condition medication (including refills, and change in titrations) during their clinic visit and day.

Exclusion Criteria:

* under age of 18 years-old;
* does not speak English or Spanish;
* dependent on assistance for medication administration;
* scored less than 4 on the six-question screener;
* not prescribed a new medication or changed medication at clinical appointment;
C: Inclusion Criteria:

* Admitted to a participating study hospital
* Diagnosis of acute coronary syndromes or heart failure

Exclusion Criteria:

* Too ill to participate
* Corrected visual acuity worse than 20/200
* Severe hearing impairment
* Patient is not being discharged to their home
* No regular telephone number
* Not fluent in English or Spanish
* Unintelligible speech
* In police custody
* Caregiver manages all medications
* Delirium or severe dementia
* Psychotic illness
* Already participating in a conflicting study
D: 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)

Answer: D