MedPath

PRIM-ER Trial Finds Palliative Care Training in Emergency Departments Does Not Reduce Hospital Admissions

The PRIM-ER trial, a significant study involving 29 emergency departments across the United States, found that a comprehensive palliative care training program for emergency staff did not decrease hospital admission rates for seriously ill older adults. Despite the lack of impact on admissions, subsequent healthcare use, or short-term mortality, the trial underscores the importance of developing primary palliative care interventions due to workforce shortages in hospice and palliative medicine.

PRIM-ER Trial Outcomes on Palliative Care Training

An extensive study known as the PRIM-ER trial has revealed that a specialized training program aimed at enhancing palliative care communication skills among emergency department staff did not result in reduced hospital admissions for seriously ill older adults. The findings, published ahead of print in JAMA, highlight the challenges in integrating palliative care into emergency medicine practices.

Study Design and Implementation

The PRIM-ER trial, supported by the NIH Pragmatic Trials Collaboratory with a grant from the National Institute on Aging, was conducted across 29 emergency departments in the United States. The program included palliative care training, simulation-based communication workshops, clinical decision support tools, and audit and feedback mechanisms. The study evaluated the initial emergency department visits of nearly 99,000 older adults with serious, life-limiting illnesses, comparing outcomes before and after the training intervention.

Key Findings

  • Primary Outcome: No significant difference in hospital admission rates was observed following the palliative care training intervention.
  • Secondary Outcomes: The intervention also did not affect subsequent healthcare use or short-term mortality rates among the study population.

Expert Commentary

Dr. Corita Grudzen, an emergency medicine physician and palliative care specialist at Memorial Sloan Kettering Cancer Center, who led the study, commented on the outcomes. "Our complex, multicomponent intervention designed to embed palliative care skills in emergency medicine practice for patients with serious, life-limiting illness did not show an effect on hospital admission, subsequent health care use, or short-term mortality," Grudzen stated. She emphasized the ongoing need for primary palliative care interventions, citing workforce shortages in hospice and palliative medicine.

Impact of COVID-19

The trial's execution between 2018 and 2022 coincided with the COVID-19 pandemic, which introduced unforeseen challenges. The strain on the healthcare system limited the capacity of home care and hospice agencies to accept patients, potentially influencing the trial's results by narrowing referral options for emergency department clinicians.

Conclusion

Despite the trial's outcomes, the PRIM-ER study contributes valuable insights into the complexities of integrating palliative care into emergency medicine. It underscores the necessity for continued research and development of effective interventions to address the needs of seriously ill older adults, especially in the context of current workforce challenges.
Subscribe Icon

Stay Updated with Our Daily Newsletter

Get the latest pharmaceutical insights, research highlights, and industry updates delivered to your inbox every day.

Related Topics

Nudge Trial: Text Message Reminders Fail to Improve Cardiovascular Medication Adherence

A pragmatic clinical trial, Nudge, found that text message reminders did not significantly improve cardiovascular medication adherence compared to usual care.
The study involved 9501 patients who had delayed refilling their cardiovascular medications and tested various text messaging strategies.

GLORIOUS Trial: Exenatide Fails to Prevent Organ Injury in Cardiac Surgery

The GLORIOUS trial assessed intravenous exenatide's impact on reducing complications during cardiopulmonary bypass-assisted cardiac surgery compared to placebo.
Results showed no significant difference in death, stroke, or organ failure between the exenatide and placebo groups over an average 5.9-year follow-up.

Emraclidine Fails to Meet Primary Endpoint in Phase II Schizophrenia Trials

AbbVie's emraclidine did not significantly reduce schizophrenia symptoms compared to placebo in Phase II EMPOWER trials, failing to meet the primary endpoint of PANSS total score reduction.
EMPOWER-1 and EMPOWER-2 trials showed similar changes in PANSS scores between emraclidine and placebo groups, with no statistically significant difference observed at week six.

Patient Death in Beam Therapeutics' Sickle Cell Trial Linked to Conditioning Regimen

A patient in Beam Therapeutics' BEACON trial of BEAM-101, a base editing therapy for sickle cell disease (SCD), died four months post-infusion due to respiratory failure.
Investigators determined the death was likely related to the busulfan conditioning regimen and not directly caused by BEAM-101, according to Beam Therapeutics.

Pulsed Shortwave Therapy Fails to Show Significant Pain Reduction After Surgery

A recent study found that pulsed shortwave therapy (PSWT) did not significantly reduce pain scores in patients after common surgeries.
The research also indicated that PSWT did not lead to a statistically significant decrease in opioid consumption during the initial postoperative week.

Tele-ICU Intervention Fails to Improve Outcomes in Critically Ill Patients: TELESCOPE Trial

A large cluster randomized trial (TELESCOPE) across 30 Brazilian ICUs evaluated the impact of tele-ICU on critically ill patients.
The tele-ICU intervention included multidisciplinary rounds led by remote intensivists, monthly audit meetings, and evidence-based protocols.

INTREPID Trial: Fever Prevention Post-Stroke Fails to Improve Functional Outcomes

The INTREPID trial demonstrated that targeted temperature management effectively reduced fever burden in ICU stroke patients compared to standard care.
Despite successful fever prevention, the study found no significant difference in functional recovery, as measured by the modified Rankin Scale (mRS) at 3 months.

Erythropoietin Fails to Show Long-Term Neuroprotective Benefits in Preterm Infants

A follow-up study of preterm infants treated with erythropoietin (rhEpo) showed no significant differences in neurodevelopmental outcomes at 10 years compared to placebo.
The study adds to a growing body of evidence from phase III trials that erythropoietin does not provide the hoped-for neuroprotective benefits in high-risk newborns.

MOST Trial: Anti-Clotting Drugs Fail to Improve Outcomes in Stroke Patients

The MOST trial investigated the efficacy of adding argatroban or eptifibatide to intravenous thrombolysis for stroke patients to prevent further clots.
Results indicated that neither argatroban nor eptifibatide improved patient outcomes and had a less than 1% probability of being helpful.

Lenvatinib-Pembrolizumab Combo Misses Survival Endpoints in Endometrial Cancer Trial

The phase III LEAP-001 trial revealed that the combination of lenvatinib and pembrolizumab did not meet survival endpoints compared to chemotherapy as a first-line therapy for advanced or recurrent endometrial cancer. However, it showed promise in specific subgroups, including those with deficient mismatch repair (dMMR) and patients who had prior neoadjuvant/adjuvant chemotherapy.

Reference News

[1]
January 21, 2025: In PRIM-ER Trial, Palliative Care Training in Emergency Departments Did ...
rethinkingclinicaltrials.org · Jan 21, 2025

A palliative care training program for emergency department teams, tested in the PRIM-ER trial, did not reduce hospital ...

© Copyright 2025. All Rights Reserved by MedPath
HomeTerms & ConditionsPrivacy Policy