Pharmacist-Led Televisits for Overmedication

Recruiting at 2 trial locations

Overseen By Sheikh Hossain, MPH

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Dementia, lacks informed consent

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

304 Participants Needed

Trial Summary

What is the purpose of this trial?

Older Veterans, particularly those with multiple chronic conditions requiring complex medication regimens, are more susceptible to adverse effects of medications. In this study, the investigators will examine the effect of a pharmacist led medication management intervention delivered by home televisit on improving medication use. The investigators anticipate that televisit to home by pharmacist for medication management may enhance use of medications at home by Veterans particularly those with complex medication regimens.

Do I need to stop my current medications for the trial?

The trial does not specify if you need to stop your current medications. It focuses on managing and improving medication use, so it's likely you will continue your current regimen.

What data supports the effectiveness of pharmacist-led televisits for medication management at home?

Research shows that pharmacist-led home visits can improve medication adherence and reduce unused medications, and telepharmacy services have been effective in managing conditions like hypertension by identifying drug-related problems. Additionally, pharmacist-led telemedicine services have been shown to reduce high-risk medication adverse events in nursing homes. ^{1 2 3 4 5}

Is pharmacist-led televisit medication management safe for humans?

Research shows that pharmacist-led medication management, including through televisits, is generally safe and can improve medication safety by identifying and addressing drug-related problems, reducing adverse drug reactions, and optimizing medication use. ^{2 6 7 8 9}

How is the pharmacist-led televisit treatment for overmedication unique?

This treatment is unique because it involves pharmacists conducting medication management through telemedicine, allowing for real-time, interactive communication with patients at home. This approach aims to improve medication safety and efficiency by providing ongoing clinical decision support and medication reconciliation, which is not typically available in standard care. ^{5 10 11 12 13}

Research Team

Lauren Rachel Moo, MD

Principal Investigator

VA Bedford HealthCare System, Bedford, MA

William W Hung, MD AB MPH

Principal Investigator

James J. Peters Veterans Affairs Medical Center

Eligibility Criteria

This trial is for older Veterans who've seen a VA primary care doctor in the past year, take at least 5 medications daily, and have at least 2 chronic conditions. It's not open to those unable to consent or with a dementia diagnosis.

Inclusion Criteria

I take 5 or more medications every day.

Had at least 1 VA primary care visit within past year

At least 2 chronic conditions

Exclusion Criteria

I have been diagnosed with dementia.

I am unable to understand or make decisions about my treatment.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive pharmacist-led medication management via home televisits

6 months

Regular televisits

Follow-up

Participants are monitored for medication appropriateness, self-efficacy, and adverse drug events

6 months

Treatment Details

Interventions

• Medication management via televisit to home

Trial Overview The study tests if managing medications through home televisits by pharmacists can improve medication use among Veterans with complex health needs. The focus is on reducing problems from taking many medicines.

Participant Groups

Group I: Intervention Experimental Treatment 1 Intervention

Receives pharmacist home televisit for medication management

Group II: Usual Care Active Control 1 Intervention

Usual care for outpatient medication management

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Findings from Research

The pharmacist-led SMASH intervention significantly reduced potentially hazardous prescribing rates by 40.7% after 12 months in 43 general practices serving over 235,000 people, demonstrating its efficacy in improving medication safety.

While the intervention also led to a 22.0% reduction in inadequate blood-test monitoring at 24 weeks, this improvement was not sustained at 12 months, indicating a need for ongoing monitoring in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of a pharmacist-led actionable audit and feedback intervention for improving medication safety in UK primary care: An interrupted time series analysis. Peek, N., Gude, WT., Keers, RN., et al.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial. [2022]

2. Japan pubmed.ncbi.nlm.nih.gov

[Nationwide study on relations between workload and outcomes of home visiting service by community pharmacists]. [2015]

3. England pubmed.ncbi.nlm.nih.gov

Clinical medication review by a pharmacist of elderly people living in care homes--randomised controlled trial. [2022]

4. Spain pubmed.ncbi.nlm.nih.gov

The impact of telepharmacy on hypertension management in the United Arab Emirates. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Transforming the Medication Regimen Review Process Using Telemedicine to Prevent Adverse Events. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Evaluation of a pharmacist-led actionable audit and feedback intervention for improving medication safety in UK primary care: An interrupted time series analysis. [2023]

7. Switzerland pubmed.ncbi.nlm.nih.gov

A Descriptive Quantitative Analysis on the Extent of Polypharmacy in Recipients of Ontario Primary Care Team Pharmacist-Led Medication Reviews. [2020]

8. United States pubmed.ncbi.nlm.nih.gov

Impact of a Clinical Pharmacist Telehealth Service in a Geriatrics Assessment Clinic. [2022]

9. England pubmed.ncbi.nlm.nih.gov

Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices. [2023]

10. Spain pubmed.ncbi.nlm.nih.gov

Pharmacists providing care in the outpatient setting through telemedicine models: a narrative review. [2020]

11. England pubmed.ncbi.nlm.nih.gov

Domiciliary medication review (ReMeDo): development, reliability and acceptability of a tool for community pharmacists. [2022]

12. United States pubmed.ncbi.nlm.nih.gov

Development of a screening tool to identify patients likely to benefit from clinical pharmacist review in a home-based primary care population. [2022]

13. New Zealand pubmed.ncbi.nlm.nih.gov

Home-based medication review in older people: is it cost effective? [2018]