A Pharmacist-led Transitions of Care Program

NCT04556786 | Completed

• 1 other identifier: 18-342 EX 1809
• Study Type: interventional
• Target: 88
• Locations: 1 country
• Sites: 1

Brief Summary

This study was to show the value of pharmacists in providing transitions of care to and improving health outcomes of uninsured populations. It also aimed to demonstrate the feasibility of implementing a transitions of care program in an indigent care clinic with limited resources. We hypothesized that a pharmacist-led transitions of care program will reduce 30-day hospital readmission rates among the uninsured discharged from a community hospital.

Conditions

Chronic Disease

Keywords

Transitions of care; Indigent population; Hospital readmission rates

Outcome Measures

Primary Outcomes (1)

• 30-day hospital readmission

  Whether a study participant had any hospital readmission 30-day post-discharge

  30-day post-discharge

Secondary Outcomes (6)

• 60-day hospital readmission

  60-day post-discharge

• 90-day hospital readmission

  90-day post-discharge

• 30-day emergency department (ED) visit

  30-day post-discharge

• 60-day emergency department (ED) visit

  60-day post-discharge

• 90-day emergency department (ED) visit

  90-day post-discharge

Study Arms (2)

Transitions of care

EXPERIMENTAL

The study participants in this aim received usual care plus medication reconciliation, daily schedule for medication taking and medical condition monitoring, and follow-up phone calls from a pharmacist.

Behavioral: Transitions of care

Usual care

NO INTERVENTION

The study participants in this arm received usual care.

Interventions

Transitions of care BEHAVIORAL

The intervention was a pharmacist-led transitions of care program that include medication reconciliation, daily schedule for medication taking and medical condition monitoring, and follow-up phone calls from a pharmacist at 60- and 90-day post-discharge in addition to the usual care.

Transitions of care

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Aged 18 years old or older
• Uninsured
• English speaking
• Discharged from East Alabama Medical Center within the past 16 days

You may not qualify if:

• Patients who did not show up for the first follow-up visit with the study pharmacist after being referred by the care coordinator at East Alabama Medical Center

Sponsors & Collaborators

• Auburn University: lead

Study Sites (1)

Mercy Medical Clinic

Auburn, Alabama, 36830, United States

Location

Related Publications (4)

• Englander H, Kansagara D. Planning and designing the care transitions innovation (C-Train) for uninsured and Medicaid patients. J Hosp Med. 2012 Sep;7(7):524-9. doi: 10.1002/jhm.1926. Epub 2012 Mar 12.

  PMID: 22411913 BACKGROUND

• Hawes EM, Maxwell WD, White SF, Mangun J, Lin FC. Impact of an outpatient pharmacist intervention on medication discrepancies and health care resource utilization in posthospitalization care transitions. J Prim Care Community Health. 2014 Jan 1;5(1):14-8. doi: 10.1177/2150131913502489. Epub 2013 Sep 17.

  PMID: 24327590 BACKGROUND

• Crotty M, Rowett D, Spurling L, Giles LC, Phillips PA. Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial. Am J Geriatr Pharmacother. 2004 Dec;2(4):257-64. doi: 10.1016/j.amjopharm.2005.01.001.

  PMID: 15903284 BACKGROUND

• Phatak A, Prusi R, Ward B, Hansen LO, Williams MV, Vetter E, Chapman N, Postelnick M. Impact of pharmacist involvement in the transitional care of high-risk patients through medication reconciliation, medication education, and postdischarge call-backs (IPITCH Study). J Hosp Med. 2016 Jan;11(1):39-44. doi: 10.1002/jhm.2493. Epub 2015 Oct 5.

  PMID: 26434752 BACKGROUND

Related Links

• Key Facts about the Uninsured Population
• America's Health Rankings

MeSH Terms

Conditions

Chronic Disease

Interventions

Patient Transfer

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Continuity of Patient Care; Patient Care; Therapeutics; Hospitalization; Health Services; Health Care Facilities Workforce and Services; Primary Health Care; Comprehensive Health Care; Patient Care Management; Health Services Administration

Study Officials

• Chiahung Chou, PhD

  Auburn University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: September 15, 2020
• First Posted: September 21, 2020
• Study Start: October 2, 2018
• Primary Completion: July 16, 2019
• Study Completion: July 16, 2019
• Last Updated: September 21, 2020

Record last verified: 2020-09

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)