Clinical trial NCT02888782: Optimizing Medication Therapy for Patients Recently Discharged From Hospital
Official title: Optimizing Medication Therapy Outcomes for Complex Patients Transitioning From Acute to Primary Care
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: NA
Conditions: Chronic Disease
Lead sponsor: Memorial University of Newfoundland
Sponsor class: OTHER
First posted: 2016-09-05
Enrollment: 89
Sex: ALL
Minimum age (years): 50
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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.


Eligibility criteria: Inclusion Criteria:

1. 50 years of age or older
2. Admitted to a General Medicine ward
3. Take 5 or more chronic medications

Exclusion Criteria:

1. Discharge to a long term care facility
2. Life expectancy less than 3 months
3. Have entered palliative care
4. Cognitive impairment (unless a responsible caregiver can provide consent and assist in participation)
5. Non-English speaking
6. Unable to provide informed consent

Primary outcomes:
measure: Composite Hospital Utilization Rate
timeFrame: 30 days post discharge
Secondary outcomes:
measure: Number of Emergency Room Visits
timeFrame: 30 days post discharge
measure: Number of Emergency Room Visits
timeFrame: 60 days post discharge
measure: Number of Emergency Room Visits
timeFrame: 90 days post discharge
measure: Rehospitalization Rate
timeFrame: 30 days post discharge
measure: Rehospitalization Rate
timeFrame: 60 days post discharge
measure: Rehospitalization Rate
timeFrame: 90 days post discharge
measure: Mortality Rate
timeFrame: 30 days post discharge
measure: Mortality Rate
timeFrame: 60 days post discharge
measure: Mortality Rate
timeFrame: 90 days post discharge
measure: Frequency of Family Physician Visits
timeFrame: 30 days post discharge
measure: Frequency of Family Physician Visits
timeFrame: 60 days post discharge
measure: Frequency of Family Physician Visits
timeFrame: 90 days post discharge
Other outcomes:
measure: Patient Satisfaction Survey
timeFrame: Collected 3 - 6 months after study enrollment
measure: Pharmacist Satisfaction Survey
timeFrame: Collected at the end of study period (12-15 months)
measure: Physician Satisfaction Survey
timeFrame: Collected at the end of study period (12-15 months)
measure: Patient quality of life Short Form Health Survey
timeFrame: Collected at time of hospital discharge
measure: Patient quality of life Short Form Health Survey
timeFrame: Collected at 30, 60 and 90 days post hospital discharge
Locations:
city: Saint John's
country: Canada
facility: Health Sciences Center
state: Newfoundland and Labrador
city: St. John's
country: Canada
facility: St. Clares Mercy Hospital
state: Newfoundland and Labrador
Study officials:
affiliation: Memorial Univeristy of Newfoundland
name: Deborah Kelly, PharmD
role: PRINCIPAL_INVESTIGATOR
References: