Impact of a mobile integrated healthcare and community paramedicine program on improving medication adherence in patients with heart failure and chronic obstructive pulmonary disease after hospital discharge: A pilot study.
Explor Res Clin Soc Pharm
; 8: 100201, 2022 Dec.
Article
em En
| MEDLINE
| ID: mdl-36457714
ABSTRACT
Background:
The mobile integrated health-community paramedicine (MIH-CP) program affiliated with the University of Maryland Medical Center focuses on improving patient transitions from hospital to home by addressing both medical and social determinants of health. Until recently, only self-contained health systems could integrate inpatient and outpatient medication data. Without some means to track patients in transition, there is a significant risk of medication-related problems and errors.Objective:
To evaluate the impact of the MIH-CP program on medication adherence among patients with congestive heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD).Methods:
This is a pilot observational study designed to compare adherence to drug regimens prescribed at hospital discharge (measured by the proportion of days covered [PDC]) between patients enrolled in the MIH-CP program and a propensity-matched control group. Propensity scores were calculated using 11 demographic, diagnostic, third-party payer, and patient care-associated variables. Discharge medication details were obtained from electronic medical records. PDC for each of the medications were calculated from pharmacy claims data.Results:
Eighty-three patients were included in the study; forty-three patients were placed in the intervention group and 40 were propensity-matched controls. After adjusting for age, sex, and third-party payer, findings indicated that medication adherence was higher among patients enrolled in the MIH-CP program compared with control during the first 30 days post-discharge, specifically among patients diagnosed with CHF (8% difference in PDC, 95% confidence interval [CI], -0.12-0.28%) and COPD (14% difference, 95% CI, -0.15-0.43%), although neither result achieved statistical significance. The differences in medication adherence between patients who were enrolled and those who were not enrolled in the MIH-CP program diminished after 30 days post-discharge.Conclusion:
This pilot study demonstrated a trend toward improved medication adherence among patients enrolled in the MIH-CP program. Future research involving a larger patient cohort will be required to confirm these preliminary findings.
ALP, Advanced Licensed Provider; CHF, Congestive Heart Failure; CHW, Community Health Worker; CI, Confidence Interval; CMS, Centers for Medicare and Medicaid Services; COPD, Chronic Obstructive Pulmonary Disease; CRISP, Chesapeake Regional Information System for our Patients; Community paramedicine; Data integration; EHR, Electronic Health Record; ICD, Institutional Classification of Diseases; IRB, Institutional Review Board; M-DRAW, Modified Drug Adherence Work-Up; MIH-CP, Mobile Integrated Health-Community Paramedicine; Medication adherence; Mobile integrated health; PDC, Proportion of Days Covered; PSM, Propensity Score Matching; SDoH, Social Determinants of Health; Telehealth; Transition of care; UMMC, University of Maryland Medical Center; UMMS, University of Maryland Medical System
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Observational_studies
Idioma:
En
Revista:
Explor Res Clin Soc Pharm
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Estados Unidos