Clinical trial NCT06605807: Optimizing Prescribing Decisions for Hospitalized Older Adults With Chronic Conditions
Official title: Optimizing Prescribing Decisions for Hospitalized Older Adults With Chronic Conditions: Aim 3
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Prescribing Decisions
Diabetes
Multimorbidity
Hypertension
Geriatrics
Keywords: prescribing
hypertension
diabetes
geriatrics
polypharmacy
multimorbidity
hospital medicine
Lead sponsor: University of Pittsburgh
Sponsor class: OTHER
Collaborators: name: National Institute on Aging (NIA)
First posted: 2024-09-20
Enrollment: 150
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The goal of this pilot clinical trial is to learn if providing a clinical decision framework for managing older adults chronic conditions during hospitalization to inpatient clinicians improves clinicians' ability to individualize chronic condition prescribing decisions for hospitalized older adults (65 and older). The main questions it aims to answer are:

* Will the clinical decision framework lead to clinicians having greater confidence to individualize discharge prescribing?
* Will clinicians using the framework discharge make fewer changes to hospitalized older adults with home diabetes and hypertension medications than they did prior to receiving the framework?
* Will older adult patients of participating clinicians will report fewer gaps in understanding of medication changes after the clinician is exposed to the framework?

Researchers will compare participating clinician survey responses and prescribing records from before and after an educational session presenting the clinical decision framework.

Participants will be asked to

* Attend a one-time educational session on the clinical decision framework
* Complete 2 electronic surveys, one before and one following the educational session.
* Agree for researchers to contact their patients, in order for patients to complete a one-time phone survey about changes made to home medications during hospitalization and quality of communication from the hospital team.


Eligibility criteria: Clinician Participants:

Inclusion Criteria:

1. Attending clinicians who practice on the general medicine or hospital medicine service at UPMC Presbyterian, UPMC Montefiore, UPMC Shadyside, UPMC Mercy, or UPMC Magee-Women's Hospital campuses.
2. Practicing on the general medicine or hospital medicine service. This population may include physicians with training in general internal medicine, hospital medicine, family practice, internal medicine subspecialities, as well as advance practice clinicians.

Exclusion Criteria:

1. Anticipating leaving current clinical position within next 3 months
2. Less than 4 weeks of inpatient attending service scheduled within 3 months of recruitment

Patient Participants:

Inclusion Criteria:

1. Adult aged 65 years or older who are hospitalized under the care of a participating clinician and discharged home.
2. Eligible patients must recieve at least one cardiometabolic medication change at hospital discharge (can include new medication starts, stops, or dose changes). Cardiometabolic medications include any class of antihypertensive, lipid lowering, anti-platelet, or glucose lowering medications regardless of indication for use.

Exclusion Criteria:

1. Incapacity for informed consent / unable to answer survey questions due to cognitive impairment
2. Enrolled in hospice care

Primary outcomes:
measure: Clinician - Change in Prescribing Self-Efficacy
timeFrame: Baseline and two months post-intervention
Secondary outcomes:
measure: Clinician - Change in Attitudes
timeFrame: Baseline and two months post-intervention
measure: Clinician - Discharge Prescribing
timeFrame: Pre-intervention and post-intervention (2 months before and 2 months after the intervention)
measure: Patient - Change in Medication Discrepencies
timeFrame: Single time survey within a week of discharge from clinician participants care.
measure: Clinician - Acceptability of Clinical Decision Framework
timeFrame: 30 days post-intervention
measure: Clinician - Change in Intentions
timeFrame: Baseline and two months post-intervention
measure: Clinician - Change in Perceived Norms
timeFrame: Baseline and two months post-intervention
measure: Clinician - Awareness of Evidence Base
timeFrame: Baseline and two months post-intervention
measure: Patient - Change in Overall Hospital Experience
timeFrame: Baseline through two months post-intervention
measure: Patient - Change in Experience in the Hospital
timeFrame: Baseline through two months post-intervention
measure: Patient - Change in Experience Leaving the Hospital
timeFrame: Baseline through two months post-intervention
measure: Patient - Change in Understanding of Medication Changes
timeFrame: Baseline through two months post-intervention
measure: Patient - Change in Comprehension of Disease Monitoring
timeFrame: Baseline through two months post-intervention
Other outcomes:
Locations:
city: Pittsburgh
country: United States
facility: University of Pittsburgh
state: Pennsylvania
Study officials:
affiliation: University of Pittsburgh
name: Timothy S Anderson, MD, MAS
role: PRINCIPAL_INVESTIGATOR
References: