Care Planning for Older Persons With Multiple Conditions: Encouraging a Tailored Approach (COMET): Stage II

Study Overview
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Brief Summary
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The purpose of the proposed project is to pilot-test in the clinic setting a computer-based clinical decision support system (CDSS) designed to optimize medication prescribing for older persons with multiple chronic conditions and polypharmacy.

Official Title
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Care Planning for Older Persons With Multiple Conditions: Encouraging a Tailored Approach (COMET): Stage II

Conditions
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Polypharmacy

Intervention / Treatment
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* Other: COMET


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Veterans age 65 years and older. Patients should be diagnosed with diabetes and hypertension and be prescribed five or more medications. Patients receiving primary care at the West Haven campus of VA Connecticut Healthcare System. Exclusion Criteria: Unable to manage own medications because of cognitive impairment. Medications prescribed by physician outside of the VA. Severe vision or hearing impairment.

Ages Eligible for Study
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Minimum Age: 65 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: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: COMET<br>The intervention consists of completion of the tool (COMET) by means of a 30 minute telephone interview prior to the primary care visit and provision of the tool's output to the patient and primary care physician. The COMET tool takes information about the patient's medications and chronic conditions from the electronic health record, and then supplements this with information obtained by a telephone interview assessing the patient's cognition, social supports, medication adherence, home medication regimen, medication side effects, and health status. In addition, there is a chart review screen to record renal function, blood pressure, and hemoglobin A1C. All of this information is run through a set of algorithms to identify medication reconciliation errors and potentially inappropriate medications. | Other: COMET<br>* The intervention consists of completion of the tool by means of a telephone interview prior to the primary care visit and provision of the tool's output to the patient and PCP.<br>|
| No Intervention: Usual Care<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Assessment of Care for Chronic Conditions (PACIC) | A modified version of the Patient Assessment of Care for Chronic Conditions (PACIC) will be used. The original tool is a 20 item instrument (100 points total) designed to assess a patients perception of one's health care (for chronic conditions). A higher score indicates a more favorable rating. | Immediately following the primary care visit at which the patient is enrolled in the study | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of changes made to the medication regimen | A chart review will be completed of the 3 months following the clinic appointment at which the patient is enrolled in the study to document any changes that were made to the medication regimen. | 3 Month Follow Up | 
| Coding of audiotapes of primary care visit | The Active Patient Participation Coding Scheme (APPC) is a validated instrument to assess indicators and facilitators of patient participation. Audio recordings will also be coded for evidence of providers' partnership building in the form of verbal encouragement to ask questions, express opinions, talk about their feelings, and participate in decision making. | The primary care visit at which the patient is enrolled in the study | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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multiple chronic conditions