Ambulatory Medication Reconciliation Following Hospital Discharge

Mass General Brigham

Status: Unknown

Conditions: Adverse Drug Events; Medication Administered in Error

Treatments: Other: Outpatient Medication Reconciliation

Study type: Interventional

Funder types: Other

Identifiers

NCT00740675

1U18 HS016790-01

Details and patient eligibility

About

Adverse drug events (ADEs) after hospital discharge are common. The purpose of this research study is see if we can design an electronic tool given to your primary care provider (PCP) that will reduce adverse drug events, hospital readmissions, and emergency department visits after you are discharged from the hospital.

Full description

The objective of this research is to reduce the incidence of post-discharge medication discrepancies, preventable and ameliorable ADEs, hospital readmissions, and ED visits through the use of HIT. The proposed tool will prompt primary care physicians to perform medication reconciliation at the first post-discharge outpatient visit, clearly display and organize preadmission and discharge medication regimens, and facilitate the creation of the new post-discharge medication list with just a few keystrokes. Using methodologies from prior studies at BWH, we will evaluate the intervention in a two-site RCT. The study will be conducted at Brigham and Women's Hospital and Massachusetts General Hospital, taking advantage of our rich experience with designing and testing new informatics applications, including one for inpatient medication reconciliation.

Enrollment: 912 estimated patients

Sex: All

Ages: 55+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Patients admitted to BWH or MGH who plan to follow up with a PCP in one of 12 primary care practices affiliated with BWH or MGH.

• Patients will need to meet the following criteria:

  • 1. be 55 years or older,
  • 2. be admitted to the participating delivery system's hospital during the study period for a non-psychiatric condition,
  • 3. have no plans to enter hospice,
  • 4. be discharged back to the community,

  • 5. be prescribed 5 or more medications at discharge, including at least one of the following:

    • antibiotics,
    • insulin,
    • antihypertensives,
    • anti-rejection,
    • antiarrhythmics,
    • inhalers,
    • antiepileptics,
    • antianginals,
    • pain medications,
    • oral hypoglycemics,
    • steroids,
    • anticoagulants.
  • These drugs were selected because they require close monitoring, increase risk for drug-drug interactions, have a narrow therapeutic window, or are known to increase risk for ADEs in the older adult population

Exclusion criteria

Unable to provide informed consent and has no proxy who administers patient's medications and can provide informed consent

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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912 participants in 2 patient groups

1

Experimental group

Description:

At post-discharge follow-up visit with PCP, PCP views: 1. Discharge medication reconciliation screen. 2. Prompts to perform post-discharge reconciliation at the first post-discharge visit.

Treatment:

Other: Outpatient Medication Reconciliation

Uusual care

No Intervention group

Description:

PCPs manage the patient's medications after hospital discharge as they normally would.