Pharmacist-Led Transition of Care Program in the Emergency Department (Pharm TOC-ED): A Pilot Trial

NCT07310199 | Recruiting

• 2 other identifiers: 2394800-1CG 838
• Study Type: interventional
• Target: 82
• Locations: 1 country
• Sites: 1

Brief Summary

When patients leave the emergency department, mistakes with their medications are common and can lead to complications or hospital readmissions. Pharmacists are trained to help prevent these problems, but pharmacist-led transition of care services are not routinely provided in emergency departments. This study is a small pilot randomized controlled trial designed to see whether a pharmacist-led transition of care program can be carried out successfully in the emergency department at Al-Wakra Hospital. The study will help determine if a larger trial is feasible in the future. Patients who are being discharged home from the emergency department and meet the study criteria will be invited to participate. Those who agree will be randomly assigned to one of two groups: Usual care, or Usual care plus the pharmacist-led transition of care program The pharmacist-led program includes reviewing the discharge prescription, checking and updating the medication list, providing medication education, arranging follow-up with a pharmacist-run clinic, communicating with outpatient pharmacists, and following up with the patient after discharge. The pilot trial will help determine how many patients are eligible, how many agree to participate, how well the intervention can be delivered in the emergency department, and whether patients and staff find it acceptable. The results will be used to plan a larger study that will test whether this program can reduce healthcare use after discharge.

Conditions

Transitional Care

Keywords

transition of care; Pharmacy services; Emergency Department

Outcome Measures

Primary Outcomes (4)

• Eligibility rate among screened patients

  Proportion of screened emergency department (ED) patients who meet all inclusion criteria and none of the exclusion criteria for the pilot trial.

  At baseline (Day 1)

• Recruitment rate among eligible patients

  Proportion of eligible patients who agree to participate, provide informed consent, and are randomized into the trial.

  At baseline (Day 1)

• Retention rate at post-discharge follow-up

  Proportion of enrolled patients who: (a) in the intervention group, attend pharmacist-led follow-up visits at 7 and 14 days after ED discharge; and (b) in both groups, complete the 30-day follow-up phone call.

  Intervention arm: Day 7, Day 14, and Day 30 after ED discharge, Control arm: Day 30 after ED discharge

• Intervention fidelity: receipt of all ToC program components

  Proportion of participants in the intervention arm who receive all prespecified components of the pharmacist-led transition of care intervention (discharge medication review, discharge medication reconciliation, patient counseling, discharge planning, and post-discharge follow-up).

  Through day 30 after ED discharge

Secondary Outcomes (9)

• Proportion of patients with ≥1 unintentional medication discrepancy

  Through day 30 after ED discharge

• Number and types of unintentional medication discrepancies

  Through Day 30 after ED discharge

• Proportion of patients with ≥1 medication therapy problem (MTP)

  Through Day 30 after ED discharge

• Number and types of medication therapy problems

  Through Day 30 after ED discharge

• Resolution of medication discrepancies and medication therapy problems

  Through Day 30 after ED discharge

Study Arms (2)

Control arm (Usual Care)

NO INTERVENTION

Patients in this group will receive standard care in accordance with Hamad Medical Corporation's (HMC) policies and practices. Currently, case review by clinical pharmacists for all ED patients at the study site is not part of routine care. Medication review, reconciliation, discharge education, and follow-up are typically managed by ED-physicians and nurses. Clinical pharmacists may be consulted, depending on availability, for complex or selected cases only. Control group patients will not be denied pharmacist-led TOC services when deemed necessary as part of routine clinical judgment. These instances will be recorded, including the reason, nature, and timing of the care provided by the pharmacist.

Multi-faceted pharmacist-led transition of care (ToC) program (Intervention)

ACTIVE COMPARATOR

Participants receive usual care plus a pharmacist-led transition of care (ToC) program, which includes medication review, reconciliation, discharge counseling, coordination of follow-up, and post-discharge pharmacist visits.

Behavioral: Multi-faceted pharmacist-led transition of care (ToC) program

Interventions

Multi-faceted pharmacist-led transition of care (ToC) program BEHAVIORAL

The pharmacist-led transition of care (ToC) intervention begins once a patient is deemed ready for ED discharge. ED pharmacists conduct a comprehensive discharge medication review, identify and resolve medication therapy problems, and document recommendations in the electronic health record (EHR). They perform discharge medication reconciliation, generate the best possible medication list, and correct any discrepancies. Pharmacists provide structured medication counseling using teach-back and address adherence barriers. Discharge planning includes scheduling post-discharge follow-up in a pharmacist-led medication therapy management clinic and delivering a standardized handover to ambulatory pharmacists. Patients receive two post-discharge follow-up visits within 7 and 14 days, during which pharmacists reassess medications, resolve new or ongoing issues, provide education, and coordinate additional care when needed. All activities follow standardized documentation procedures.

Multi-faceted pharmacist-led transition of care (ToC) program (Intervention)

Eligibility Criteria

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

You may qualify if:

• Adults (aged 18 years or more) discharged from the ED with at least one of the following:
• Polypharmacy: Five or more scheduled prescription medications for chronic illnesses (i.e., chronic maintenance medications, even if such medications were not refilled during the index ED visit)
• Discharged with a new prescription of high-risk medication, including:
• Drugs with the potential of withdrawal symptoms upon abrupt discontinuation such as antipsychotics, antiepileptics, antidepressants, and tapering glucocorticoids.
• Insulin (initiation or intensification of therapy)
• Oral hypoglycemic agents
• Visiting ED for an exacerbation of chronic illness (e.g., exacerbation of asthma, COPD, CHF, uncontrolled diabetes mellitus, hypertension urgency, uncontrolled epilepsy)

You may not qualify if:

• The following patients will be excluded:
• Presenting with acute minor illnesses
• Lack of decision-making capacity (including documented moderate or severe dementia, altered mental status, unstable psychiatric illness, altered consciousness level, lack of orientation to person/place/time as reported in EHR, delirium, patients seen in the ED for a psychiatric evaluation)
• Language barrier, i.e., inability to communicate in either English or Arabic as the intervention will be provided by English/Arabic speaking clinical pharmacists
• Expected length of stay in Qatar of \<30 days post discharge (including transit passengers)
• Substance use disorders (e.g., alcoholism, opioid dependency) or drug-seeking behavior, as reported in EHR
• Prisoners who are serving an active sentence
• Patients presenting for non-medical, socially driven reasons (e.g., seeking shelter, support, or resources) with no identifiable acute medical condition, and known to the ED team as recurrent visitors.
• Discharge to a location other than home (e.g., patients transferred to another hospital, long-term or skilled nursing facility)
• Study pharmacists unavailable to deliver the intervention if the patients were randomized to the intervention arm
• Pregnant women
• Patients seen for trauma or planned surgery
• Terminally ill patients
• Patients discharged from ED with watchful waiting (e.g., expected to be readmitted for an intervention such as surgical intervention if conservative management failed)
• Patients who are admitted to the hospital after enrollment (i.e., following consent but prior to ED discharge)

Sponsors & Collaborators

• Dr. Muhammad Abdul Hadi: lead
• Hamad Medical Corporation: collaborator

Study Sites (1)

Al- Wakra Hospital- Hamad Medical Corporation

Al Wakrah, Qatar

RECRUITING

MeSH Terms

Conditions

Emergencies

Interventions

RHBDF2 protein, human

Condition Hierarchy (Ancestors)

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

Central Study Contacts

Muhammad Abdul Hadi, PhD

CONTACT

0097433114549; mabdulhadi@qu.edu.qa

Eman Alhmoud, MSc

CONTACT

0097455572121; ea2201377@qu.edu.qa

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Associate Professor of Clinical Pharmacy and Practice

Study Record Dates

• First Submitted: December 14, 2025
• First Posted: December 30, 2025
• Study Start: January 19, 2026
• Primary Completion (Estimated): August 11, 2026
• Study Completion (Estimated): April 10, 2027
• Last Updated: January 21, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

QA (1)