期刊
CONTEMPORARY CLINICAL TRIALS
卷 106, 期 -, 页码 -出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.cct.2021.106419
关键词
Adverse drug events; Medication management; Geriatrics; Readmissions; Pharmacist
资金
- National Institute on Aging of the National Institutes of Health, United States [R01AG058911]
- NIH National Center for Advancing Translational Science (NCATS) UCLA CTSI [UL1TR001881]
This study aims to reduce hospital readmissions in older adults through pharmacist-led peri-discharge interventions, using a pragmatic approach and randomized clinical trial design. The research will investigate the impact of various interventions on readmission rates, as well as barriers to and facilitators of implementing the PHARM-DC intervention.
Background: Older adults commonly face challenges in understanding, obtaining, administering, and monitoring medication regimens after hospitalization. These difficulties can lead to avoidable morbidity, mortality, and hospital readmissions. Pharmacist-led peri-discharge interventions can reduce adverse drug events, but few large randomized trials have examined their effectiveness in reducing readmissions. Demonstrating reductions in 30-day readmissions can make a financial case for implementing pharmacist-led programs across hospitals. Methods/Design: The PHARMacist Discharge Care, or the PHARM-DC intervention, includes medication reconciliation at admission and discharge, medication review, increased communication with caregivers, providers, and retail pharmacies, and patient education and counseling during and after discharge. The intervention is being implemented in two large hospitals: Cedars-Sinai Medical Center and the Brigham and Women's Hospital. To evaluate the intervention, we are using a pragmatic, randomized clinical trial design with randomization at the patient level. The primary outcome is utilization within 30 days of hospital discharge, including unforeseen emergency department visits, observation stays, and readmissions. Randomizing 9776 patients will achieve 80% power to detect an absolute reduction of 2.5% from an estimated baseline rate of 27.5%. Qualitative analysis will use interviews with key stakeholders to study barriers to and facilitators of implementing PHARM-DC. A costeffectiveness analysis using a time-and-motion study to estimate time spent on the intervention will highlight the potential cost savings per readmission. Discussion: If this trial demonstrates a business case for the PHARM-DC intervention, with few barriers to implementation, hospitals may be much more likely to adopt pharmacist-led peri-discharge medication management programs.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据