Optimizing Medication Therapy for Patients Recently Discharged From Hospital

Study Overview
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Brief Summary
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Patients who are discharged from hospital can be overwhelmed when they suddenly have to manage new conditions or medications. These changes can be particularly difficult for people on many medications or with multiple health conditions. There is a real risk that this will lead to emergency room visits, hospital readmission, and even death. In addition to endangering patients, these adverse events are very costly to the healthcare system. The good news is that these events can be preventable if patients receive care that is better coordinated. Patient-oriented research will be conducted to determine if a pharmacist-led medication therapy management service can improve health outcomes of 'medically complex' patients transitioning from acute to primary care in Newfoundland and Labrador (NL). This a more comprehensive service than their community pharmacist would normally provide. The program will use a new Pharmacist Clinic service to provide care and support which does not currently exist for patients in NL after they leave hospital. After discharge, patients will be randomly divided into two groups: one group will receive care as usual from their doctor; the other group will have their medications assessed by a clinic pharmacist within one week of hospital discharge along with their usual care from their doctor. The two groups will be compared to determine whether specialized pharmacist services after hospital discharge is satisfactory to patients/providers, improves patient health, and reduces emergency room visits, hospital readmissions, and repeat trips to the doctor. If successful, this project will help ensure that patients are taking the right medications in the right way, improving individual health and making better use of healthcare system resources.

Official Title
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Optimizing Medication Therapy Outcomes for Complex Patients Transitioning From Acute to Primary Care

Conditions
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Chronic Disease

Intervention / Treatment
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* Other: Pharmacist Consultation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 50 years of age or older Admitted to a General Medicine ward Take 5 or more chronic medications Exclusion Criteria: Discharge to a long term care facility Life expectancy less than 3 months Have entered palliative care Cognitive impairment (unless a responsible caregiver can provide consent and assist in participation) Non-English speaking Unable to provide informed consent

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pharmacist Consultation<br>Meet with pharmacist for consultation in addition to regular physician follow up | Other: Pharmacist Consultation<br> <br> |
| No Intervention: Control<br>Receive regular physician follow up | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Composite Hospital Utilization Rate | A composite score of hospital readmission rate and ER visits | 30 days post discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Emergency Room Visits |  | 30 days post discharge | 
| Number of Emergency Room Visits |  | 60 days post discharge | 
| Number of Emergency Room Visits |  | 90 days post discharge | 
| Rehospitalization Rate |  | 30 days post discharge | 
| Rehospitalization Rate |  | 60 days post discharge | 
| Rehospitalization Rate |  | 90 days post discharge | 
| Mortality Rate |  | 30 days post discharge | 
| Mortality Rate |  | 60 days post discharge | 
| Mortality Rate |  | 90 days post discharge | 
| Frequency of Family Physician Visits |  | 30 days post discharge | 
| Frequency of Family Physician Visits |  | 60 days post discharge | 
| Frequency of Family Physician Visits |  | 90 days post discharge |