Heart Failure, Pulmonary Disease, Chronic Obstructive
Conditions
Keywords
transition of care, care transitions, readmission, medication, adherence, medication management, medication reconciliation, patient counseling, pharmacist
Brief summary
The purpose of this pilot study is to determine if medication adherence is improved by a transitional care pharmacy practice model designed to integrate hospital and community pharmacists in the care and education of patients with heart failure or COPD who are discharged from a community hospital to home. The hospital and community pharmacists will collaborate with each other, the patient, and other practitioners including the primary care physician, nurse, and case manager to prevent and correct medication-related problems and attempt to improve patient outcomes especially during the error-prone transition from hospital to home.
Interventions
PROCEDUREPharmacist Counseling
The hospital pharmacist will meet with the patient and complete medication reconciliation, assess the patient's understanding of the medications, and identify medication-related problems. The hospital pharmacist will complete a pharmacist discharge care plan and a copy will be sent to the participating community pharmacist. The patients will be scheduled for the first meeting with their community pharmacist within 1 week of hospital discharge. The community pharmacist will interview the patient about their general health and any current symptoms of heart failure or COPD, identify any additional medication-related problems, follow-up on any issues as described in the pharmacist discharge care plan, and provide patient education. The patients will then meet with their community pharmacist for counseling and patient education at monthly intervals for 6 months following hospital discharge.
Sponsors
Moses Taylor Hospital Foundation
Commonwealth Health
Community Pharmacy Foundation
Wilkes University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* admitted to hospital with a primary or secondary diagnosis of heart failure or COPD * anticipated eventual discharge to home * agreeable to participate in monthly counseling sessions (if randomized to intervention group) from a participating community pharmacist
Exclusion criteria
* presence of cognitive impairment or dementia that would significantly prevent effective patient education and counseling * non English-speaking * anticipated discharge to a long-term care or skilled nursing facility on a permanent basis * permanent long-term care facility residents * surgical patients * hospice patients * patients who die within 30 days of initial study hospitalization
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Medication Adherence | 6 months | The primary endpoint will be medication adherence as measured by the Proportion of Days Covered (PDC) calculation. This is calculated by dividing the total days' supply dispensed by 180 days. Medications considered in this calculation will include those used for the treatment of heart failure or COPD and known to improve outcomes. The composite PDC will be an average of the individual PDC for each drug class. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Medication related problems | 6 months | Actual or potential medication-related problems (MRP) that are identified by the hospital and participating community pharmacists will be categorized based on an MRP classification tool. |
| Patient Satisfaction | 6 months | The Care Transitions Measure (CTM-3) is a validated survey to assess the patient's satisfaction with the quality of transitional care during hospitalization and will be completed by the patient following hospital discharge. The patient's satisfaction with the services provided by the community pharmacies will be assessed with the Consumer Experience with Pharmacy Services survey (© Pharmacy Quality Alliance). |
| Hospital readmissions or ED visits | 6 months | Hospital readmissions are defined as an unplanned and overnight admission to the hospital |
Countries
United States
Outcome results
None listed