Electronic Medication Adherence Reporting and Feedback During Care Transitions
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 207
- 试验地点
- 1
- 主要终点
- Medication Adherence
研究概览
简要总结
Patients often have problems with their medications after leaving the hospital and going back home. The goals of this study are to provide a special electronic pill-box with pre-filled weekly medication trays that can alert patients when it is time to take their medications, alert family members (with patients' permission) if there is a problem, and produce a report of medication-taking habits for patients' primary care providers. The investigators will evaluate the effects of this technology on patients' ability to take their medications safely, on the control of chronic conditions like high blood pressure, and also ask patients about any barriers to using this technology in the real world. The investigators hypothesize that a smart pillbox (i) can be successfully implemented in the transitions setting, including engagement of patients, caregivers, and providers in electronically available medication adherence reports; (ii) will decrease medication discrepancies and increase medication adherence in the 6 months after hospital discharge; and (iii) among patients with hypertension, diabetes mellitus, and hyperlipidemia will improve routinely collected measures of disease control.
详细描述
Adverse drug events are very common after hospitalization and are due to a variety of factors, including misunderstanding of the correct medication regimen and non-adherence with that regimen. The goals of this study are to implement and evaluate a novel "smart pillbox" using health information technology (HIT) to minimize discrepancies in prescribed regimens and improve adherence after hospital discharge. To the investigators' knowledge this type of technology has not been studied in the transitions setting, where there are unique challenges but also tremendous opportunities to engage patients, caregivers, and providers in medication safety and to improve care.
Specific Aims:
- Implement a smart pillbox intervention for patients discharged from the hospital to the community
a. Hypothesis 1: a smart pillbox can be successfully implemented in the transitions setting, including engagement of patients, caregivers, and providers in electronically available medication adherence reports 2. Evaluate the effects of the intervention on post-discharge medication discrepancies, medication adherence, and chronic disease management
- Hypothesis 2a: a smart pillbox intervention will decrease medication discrepancies and increase medication adherence in the 6 months after hospital discharge
- Hypothesis 2b: among patients with hypertension, diabetes mellitus, and hyperlipidemia, a smart pillbox intervention will improve routinely collected measures of disease control
- Determine barriers and facilitators of implementation of the intervention
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Admitted to the medicine service of a large, urban hospital
- •Taking 5 or more chronic medications
排除标准
- •Plan to discharge patient to hospice, rehabilitation, or skilled nursing facility (i.e., not to the community)
研究组 & 干预措施
Usual Care
Patients receive usual care and can continue using their existing pharmacy.
Smart Pillbox
Patients receive pre-filled medication trays from Curant Health Pharmacy or the Brigham and Women's Hospital Outpatient Pharmacy. The smart pillbox in which pre-filled medication trays are housed provide automated medication reminders.
干预措施: pre-filled medication trays (Other)
Smart Pillbox
Patients receive pre-filled medication trays from Curant Health Pharmacy or the Brigham and Women's Hospital Outpatient Pharmacy. The smart pillbox in which pre-filled medication trays are housed provide automated medication reminders.
干预措施: automated medication reminders (Other)
结局指标
主要结局
Medication Adherence
时间窗: 6 months after discharge
Proportion of patients with Proportion of Days Covered (PDC) \> 80% or Proportion of patients with Daily Polypharmacy Possession Ratio (DPPR) \> 80%.
Medication Discrepancies
时间窗: Monthly for the 6 months after discharge
Number of discrepancies per patient (mean per month)
次要结局
- Blood Pressure Control (in patients on antihypertensive medications)(Minimum of 6 months)
- Use of adherence reports by caregivers [intervention arm only](Cumulative during the 6 months after discharge)
- Biweekly delivery of trays [intervention arm only](Biweekly for the 6 months after discharge)
- Use of adherence reports by patients [intervention arm only](Cumulative during the 6 months after discharge)
- 14-day adherence [intervention arm only](14 day-period)
- Proportion of regimen in pill trays [intervention arm only](Biweekly for the 6 months after discharge)
- Actions taken by providers [intervention arm only](Cumulative during the 6 months after discharge)
- LDL Cholesterol Control (in patients on statins)(Minimum of 6 months)
- Use of adherence reports by Partners HealthCare providers [intervention arm only](Cumulative during the 6 months after discharge)
- Diabetes Control (in patients on diabetes medications)(Minimum of 6 months)
研究者
Jeffrey L. Schnipper, MD.,MPH.
Associate Professor of Medicine
Brigham and Women's Hospital