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- Title
Improving medication prescribing-related outcomes for vulnerable elderly in transitions on high-risk medications (IMPROVE-IT HRM): a pilot randomized trial protocol.
- Authors
Holbrook, Anne; Perri, Dan; Levine, Mitch; Mbuagbaw, Lawrence; Jarmain, Sarah; Thabane, Lehana; Tarride, Jean-Eric; Dolovich, Lisa; Hyland, Sylvia; Telford, Victoria; Silva, Jessyca; Nieuwstraten, Carmine
- Abstract
Background: Seniors with recurrent hospitalizations who are taking multiple medications including high-risk medications are at particular risk for serious adverse medication events. We will assess whether an expert Clinical Pharmacology and Toxicology (CPT) medication management intervention during hospitalization with follow-up post-discharge and communication with circle of care is feasible and can decrease drug therapy problems amongst this group. Methods: The design is a pragmatic pilot randomized trial with 1:1 patient-level concealed randomization with blinded outcome assessment and data analysis. Participants will be adults 65 years and older admitted to internal medicine services for more than 2 days, who have had at least one other hospitalization in the prior year, taking five or more chronic medications including at least one high-risk medication. The CPT intervention identifies medication targets; completes consult, including priorities for improving prescribing negotiated with the patient; starts the care plan; ensures a detailed discharge medication reconciliation and circle-of-care communication; and sees the patient at least twice after hospital discharge via virtual visits to consolidate the care plan in the community. Control group receives usual care. Primary outcomes are feasibility — recruitment, retention, costs, and clinical — number of drug therapy problems improved, with secondary outcomes examining coordination of transitions in care, quality of life, and healthcare utilization and costs. Follow-up is to 3-month posthospital discharge. Discussion: If results support feasibility of ramp-up and promising clinical outcomes, a follow-up definitive trial will be organized using a developing national platform and medication appropriateness network. Since the intervention allows a very scarce medical specialty expertise to be offered via virtual care, there is potential to improve the safety, outcomes, and cost of care widely. Trial registration number: ClinicalTrials.gov identifier: NCT04077281.
- Subjects
DRUG therapy; MEDICAL protocols; MEDICAL specialties &; specialists; MEDICATION therapy management; MEDICATION reconciliation; OLDER patients; FRAIL elderly
- Publication
Pilot & Feasibility Studies, 2024, Vol 10, Issue 1, p1
- ISSN
2055-5784
- Publication type
Article
- DOI
10.1186/s40814-024-01484-6