Determining the Impact of a Medication Delivery Unit on Medication Adherence Immediately Following Hospitalization of Adults With Common Cardiac Conditions

Care transition interventions have been successful in reducing medication-related problems and associated rehospitalization primarily by focusing on medication reconciliation conducted by trained healthcare professionals. Programs to improve the medication reconciliation process have largely been effective but have limitations, including: the expenses associated with recruiting, training, and retaining care transition healthcare professionals; the ability to provide services within a finite geographic area; and the retrospective nature of the reconciliation process, which usually occurs in the home following hospital discharge.

Our short-term objective is to determine the impact of the INRange Systems Electronic Medication Management Assistant (EMMA) medication delivery unit (MDU) for adults that require medication assistance in their home immediately following an acute hospitalization with a diagnosis of a common cardiac condition. As part of this study, we will determine: (1) Medication adherence rates (# doses/doses scheduled; EMMA (intervention) vs. determined by manual monthly pill counts at days 1, 45 and 90 (control)); (2) Health service utilization; (3) Health economic assessment from health plan and societal perspectives; (4) Medication administration errors; (5) Patient experience and satisfaction; (6) Medication reconciliation errors (using medication discrepancy tool); (7) 30-day readmission rates; and (8) Factors related to continued use of the EMMA MDU.

Study Overview and Design: The research study design associated with this proposal is a randomized controlled trial (RCT) design. The primary endpoint is to compare medication adherence of adult patients recently hospitalized with a diagnosis of congestive heart failure who require medication assistance either by receiving usual care (i.e., the control group; take medications as they had before hospitalization) or by using a medication delivery unit (i.e., the intervention group; take medications only from the device, which will always differ from the usual way in which medications were taken prior to hospitalization).

Study duration: The overall study will last a total of 12 months. Each subject will be enrolled for a period of 90 days regardless of unit of randomization (i.e., control/usual care vs. intervention).

Subject Recruitment: One-hundred and sixty patients > 18 years old who are admitted to UPMC Presbyterian Hospital will be considered as potential study participants. Records of these patients will be pre-screened within 24 hours of admittance using inclusion and exclusion criteria that can be assessed without direct patient contact.