Enhancing Timely Access to Medication Changes: The Role of Pharmacists in Overcoming Transitions of Care Challenges

The Guthrie Clinic

Status: Completed

Conditions: Transitional Care

Treatments: Behavioral: Unplanned healthcare encounter

Study type: Observational

Funder types: Other

Identifiers

NCT07018232

2411-102

Details and patient eligibility

About

Objective: Among patients discharged from the hospital with changes in maintenance prescription medication, how does experiencing a medication access gap compared to a no medication access gap impact the time to first unplanned healthcare encounter?

This is a retrospective, cohort study conducted at two hospital sites in rural Pennsylvania and New York State using encounter data from the electronic health record to analyze any patient discharged with medication changes from June 1, 2023 to May 31, 2024.

Full description

Background: Transitions of care are high-risk periods marked by frequent medication-related problems with up to 80% of discharged patients and 98% of older adults experiencing discrepancies in their medication regimens. These gaps, often due to delayed prescription refills or poor care coordination, contribute to unplanned healthcare encounters, increased costs, and strain on providers. Pharmacists can mitigate these risks by improving medication access and continuity.

Objective: Among patients discharged from the hospital with changes in maintenance prescription medication, how does experiencing a medication access gap compared to a no medication access gap impact the time to first unplanned healthcare encounter?

This is a retrospective, cohort study conducted at two hospital sites in rural Pennsylvania and New York State using encounter data from the electronic health record to analyze any patient discharged with medication changes from June 1, 2023 to May 31, 2024.

Enrollment: 104 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 18 years and older
• Have a Guthrie primary care provider
• Discharged from the hospital to home or self-care (routine)
• Had a medication change on discharge based on a discharge summary and/or after visit summary (AVS) containing "start taking these medications", "continue these medications which have changed", and/or "stop taking these previous medications".

Exclusion criteria

• Age less than 18 years of age
• Do not have a Guthrie primary care provider
• Discharged from the hospital to anywhere besides home or self-care (routine) such as to rehabilitation, long-term care, left against medical advice, or transferred to another type of healthcare institution
• prescriptions on discharge that lack e-prescribing class
• prescriptions on discharge for day supplies less than 28 days
• prescriptions on discharge for day supplies greater than 45 days
• prescriptions on discharge with 1 or more refills provided
• prescriptions on discharge for as needed medications
• prescriptions on discharge for anti-infective agent
• prescriptions on discharge for short-term steroids
• prescriptions on discharge for nausea medication
• prescriptions on discharge for bowel regimen medication
• prescriptions on discharge for diabetic or medical supplies
• prescriptions on discharge for topical medications
• prescriptions on discharge for cough suppressants,
• prescriptions on discharge for vitamins and supplements
• prescriptions on discharge for medications that can be purchased over the counter

Trial design

104 participants in 2 patient groups

Medication Gap

Description:

A patient with a medication gap was defined as 1) having lapse in prescription coverage or any number of days where they were out of a maintenance prescription medication because the primary care provider did not send in a refill in time, and 2) having a medication access barrier, such as needing to contact the primary care provider to send in a refill for a maintenance prescription medication.

Treatment:

Behavioral: Unplanned healthcare encounter

No Medication Gap

Description:

A patient with no medication gap was defined as having zero days without a maintenance prescription medication because it was appropriately refilled by their primary care provider at a transitions of care follow-up appointment

Treatment:

Behavioral: Unplanned healthcare encounter