Discharge Planning for Elderly Patients in the Emergency Department: Use of a Brief Phone Call After Discharge to Improve Medication Utilization and Physician Follow-up

Study Overview
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Brief Summary
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The investigators hypothesize that the acquisition and correct utilization of medications as well as arranging and attending follow-up appointments will improve as a result of a phone call intervention 1-3 days after elderly patients are discharged from the emergency department (ED).

Detailed Description
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Older patients seen in the ED are at high risk of functional decline and return visits to the ED. Previous studies have shown that a comprehensive assessment by a geriatric specialist at the time of discharge from the ED along with extensive integration with home services and/or referral to community services can decrease functional decline and return visits to the ED as well as increase patient satisfaction, but this intervention is resource intensive requiring a geriatric discharge specialist to be available to the emergency department 24 hours a day/ 7 days a week. It is also known that in other patient populations telephone reminders to make follow up appointments can increase rate of follow up and that comprehension of discharge instructions is the primary barrier to compliance with discharge instructions. It has been shown that telephone follow-up interviews are feasible for geriatric patients discharged from the ED, and that many elderly patients discharged from the ED do not understand their discharge instructions or attend follow-up appointments. However, there are no published studies evaluating whether a follow up telephone call after discharge from the ED can improve patient compliance with the medical treatment plan including obtaining follow - up appointments and obtaining prescribed medications as well as using them appropriately. We seek to determine if we can increase compliance with medications and outpatient follow up with a phone call from a nurse provider 1-3 days after discharge.

Official Title
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Discharge Planning for Elderly Patients in the Emergency Department: Use of a Brief Phone Call After Discharge to Improve Medication Utilization and Physician Follow-up

Conditions
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Patient Discharge

Intervention / Treatment
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* Other: Phone call follow-up
* Other: Satisfaction survey
* Other: Control group --- no intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 65 or over Discharged from the UNC emergency department Exclusion Criteria: In the hospital at the time of phone call follow-up Neither the patient nor their responsible party are able to pass a standardized test to assess cognitive function

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: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Follow-up phone call from Nurse<br>Patients in this are will receive a phone call follow-up from a nurse 1-3 days after their discharge from the ED. | Other: Phone call follow-up<br>* A nurse will call the patient to counsel patients on their medications and following up with their primary care provider.<br>|
| Placebo Comparator: Satisfaction survey<br>This group of patients will receive a phone call from a student who will conduct a brief satisfaction survey of the patient's experience in the ED. | Other: Satisfaction survey<br>* Patients will be given a satisfaction survey.<br>|
| Placebo Comparator: Control group<br>Patients in this group will receive no phone call at 1-3 days. | Other: Control group --- no intervention<br>* Control group<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Whether patient obtained medications prescribed at their discharge from ED |  | 5-8 days after discharge from ED | 
| Whether patient is using medications that were prescribed at their ED discharge correctly |  | 5-8 days after discharge from ED | 
| Whether the patient arranged a follow-up appointment with their primary care provider |  | 5-8 days after discharge from ED | 
| Whether patient attended visit with their primary care provider after discharge from the ED |  | 30-35 days after discharge from ED | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient's satisfaction with ED visit |  | 5-8 days after discharge from the ED | 
| Return to the ED within 30 days of initial visit |  | 30-35 days after discharge from ED | 
| Cost of the intervention |  | 35 days after last patient enrolled | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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emergency medicine, primary care physicians