Clinical trial NCT01207180: 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
Official title: 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 type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Patient Discharge
Keywords: emergency medicine
primary care physicians
Lead sponsor: University of North Carolina, Chapel Hill
Sponsor class: OTHER
Collaborators: name: The Duke Endowment
First posted: 2010-09-22
Enrollment: 157
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: Whether patient obtained medications prescribed at their discharge from ED
timeFrame: 5-8 days after discharge from ED
measure: Whether patient is using medications that were prescribed at their ED discharge correctly
timeFrame: 5-8 days after discharge from ED
measure: Whether the patient arranged a follow-up appointment with their primary care provider
timeFrame: 5-8 days after discharge from ED
measure: Whether patient attended visit with their primary care provider after discharge from the ED
timeFrame: 30-35 days after discharge from ED
Secondary outcomes:
measure: Patient's satisfaction with ED visit
timeFrame: 5-8 days after discharge from the ED
measure: Return to the ED within 30 days of initial visit
timeFrame: 30-35 days after discharge from ED
measure: Cost of the intervention
timeFrame: 35 days after last patient enrolled
Other outcomes:
Locations:
city: Chapel Hill
country: United States
facility: University of North Carolina Emergency Department
state: North Carolina
Study officials:
affiliation: University of North Carolina, Chapel Hill
name: Kevin J Biese, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Biese K, Lamantia M, Shofer F, McCall B, Roberts E, Stearns SC, Principe S, Kizer JS, Cairns CB, Busby-Whitehead J. A randomized trial exploring the effect of a telephone call follow-up on care plan compliance among older adults discharged home from the emergency department. Acad Emerg Med. 2014 Feb;21(2):188-95. doi: 10.1111/acem.12308.