Effect of a care transition intervention by pharmacists: an RCT.

BACKGROUND: Pharmacists may improve medication-related outcomes during transitions of care. The aim of the Iowa Continuity of Care Study was to determine if a pharmacist case manager (PCM) providing a faxed discharge medication care plan from a tertiary care institution to primary care could improve medication appropriateness and reduce adverse events, rehospitalization and emergency department visits. METHODS: Design. Randomized, controlled trial of 945 participants assigned to enhanced, minimal and usual care groups conducted 2007 to 2012. Subjects. Participants with cardiovascular-related conditions and/or asthma or chronic obstructive pulmonary disease were recruited from the University of Iowa Hospital and Clinics following admission to general medicine, family medicine, cardiology or orthopedics. Intervention. The minimal group received admission history, medication reconciliation, patient education, discharge medication list and medication recommendations to inpatient team. The enhanced group also received a faxed medication care plan to their community physician and pharmacy and telephone call 3-5 days post-discharge. Participants were followed for 90 days post-discharge. Main Outcomes and Measures. Medication appropriateness index (MAI), adverse events, adverse drug events and post-discharge healthcare utilization were compared by study group using linear and logistic regression, as models accommodating random effects due to pharmacists indicated little clustering. RESULTS: Study groups were similar at baseline and the intervention fidelity was high. There were no statistically significant differences by study group in medication appropriateness, adverse events or adverse drug events at discharge, 30-day and 90-day post-discharge. The average MAI per medication as 0.53 at discharge and increased to 0.75 at 90 days, and this was true across all study groups. Post-discharge, about 16% of all participants experienced an adverse event, and this did not differ by study group (p > 0.05). Almost one-third of all participants had any type of healthcare utilization within 30 days post-discharge, where 15% of all participants had a 30-day readmission. Healthcare utilization post-discharge was not statistically significant different at 30 or 90 days by study group. CONCLUSION: The pharmacist case manager did not affect medication use outcomes post-discharge perhaps because quality of care measures were high in all study groups. TRIAL REGISTRATION: Clinicaltrials.gov registration: NCT00513903, August 7, 2007.

The Iowa Continuity of Care study: Background and methods.

PURPOSE: The background and methods of an ongoing study to determine the effects of hospital pharmacists' enhanced communication with patients and their community providers are described. SUMMARY: The Iowa Continuity of Care study is a randomized, prospective trial enrolling 1000 patients with selected medical conditions admitted to one large Midwest hospital. Patients will be randomized to a control group (usual care), minimal intervention, or enhanced intervention. For the intervention groups, a pharmacist case manager (PCM) will provide admission medication verification with the patients' community pharmacists, medication teaching, and discharge counseling. Patients in the enhanced intervention group will have a discharge care plan faxed to their outpatient physician and community pharmacist and will receive a follow-up phone call from the PCM three to five days after discharge; the PCM will continue to facilitate communication between the patient and community providers until all medication problems are resolved. A blinded research nurse will collect data, including adverse drug event (ADE) data, at admission and 30 and 90 days after discharge. The primary outcome measures include medication appropriateness, ADEs, emergency department visits, unscheduled office visits, and rehospitalizations. Data will be collected from the inpatient electronic medical record, outpatient physician medical records, and community pharmacist records and directly from patients. A cost-effectiveness analysis will be performed. CONCLUSION: This study will address the value of a PCM in improving communication of care plans between the inpatient and community settings and thereby optimizing medication use.