Pharmacist-Assisted Medication Transition for Care Transitions

Overseen By Shalynn Howard, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Washington

Disqualifiers: Under 18, Hospice care, others

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

Compensation: Varies

Number of Visits: Unknown

5760 Participants Needed

Trial Summary

What is the purpose of this trial?

The Pharmacy Integrated Transitions (PIT) program, utilizes a crossover randomized control design to evaluate the impact of a clinical pharmacist in decreasing medication related problems during a patient's transition from hospital to skilled nursing facility (SNF).

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on the role of a pharmacist in managing medication transitions, so it's best to ask the trial coordinators for more details.

What data supports the effectiveness of the Pharmacy Integrated Transitions (PIT) program treatment?

Research shows that pharmacy-supported interventions during care transitions can improve medication safety by reducing medication discrepancies and potential adverse drug events. However, the impact on hospital readmissions and healthcare costs is mixed, and there is no significant effect on mortality. ^{1 2 3 4 5}

Is the Pharmacist-Assisted Medication Transition program safe for humans?

Pharmacist-supported interventions during care transitions are generally considered safe and can improve medication safety by reducing medication-related harm, especially in older adults. However, these interventions do not significantly affect mortality rates, and their impact on healthcare costs and hospital visits is mixed. ^{4 6 7 8 9}

How is the Pharmacy Integrated Transitions (PIT) program different from other treatments for care transitions?

The Pharmacy Integrated Transitions (PIT) program is unique because it involves a pharmacist or pharmacy technician coordinating medication needs during patient discharge, aiming to improve patient satisfaction and reduce medication errors. Unlike other treatments, this program specifically targets the transition of care process, which is a vulnerable time for patients, by ensuring proper medication management and communication between healthcare settings. ^{4 7 10 11 12}

Research Team

Giana Davidson, MD MPH

Principal Investigator

University of Washington

Eligibility Criteria

This trial is for adults over 18 transitioning from certain hospitals to independent skilled nursing facilities. It's not for those under 18 or patients moving to hospice care.

Inclusion Criteria

I am 18 years old or older.

Patients receiving inpatient care at University of Washington Mountlake, University of Washington Northwest, Harborview, and Valley Medical Center hospitals with a planned discharge to collaborating independently operating skilled nursing facility sites.

Exclusion Criteria

I am younger than 18 years old.

I am being discharged to enter hospice care.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Transition

A clinical pharmacist conducts a comprehensive medication review, including medication reconciliation, adjustment, and monitoring during the transitional period from hospital to SNF, along with a structured handoff between clinical teams.

During hospital discharge

Follow-up

Participants are monitored for medication-related problems, readmissions, and deaths within 30 days post hospital discharge.

30 days

Treatment Details

Interventions

• Pharmacy Integrated Transitions (PIT) program

Trial Overview The study tests a Pharmacy Integrated Transitions program where a clinical pharmacist helps manage medication during the move from hospital to skilled nursing facility, using a crossover randomized control design.

Participant Groups

Group I: Clinical Pharmacist in Transition of Care Experimental Treatment 4 Interventions

A clinical pharmacist will be provided as a patient discharges from one of four University of Washington (UW) medical centers to one of 14 post acute skilled nursing facilities randomized to the intervention arm. The coordinating transitional pharmacist will conduct (1) a comprehensive medication review including medication reconciliation, adjustment, and monitoring during the transitional period from hospital to SNF, 2) a structured handoff between clinical teams at the hospital and SNF.

Group II: Patient transitions from hospital to post-acute care Active Control 1 Intervention

Patient will transition from one of four University of Washington (UW) medical centers to one of 14 post-acute skilled nursing facilities randomized to the control arm. Patients will receive the standard discharge process.

Who Is Running the Clinical Trial?

University of Washington

Lead Sponsor

Trials

1,858

Recruited

2,023,000+

Agency for Healthcare Research and Quality (AHRQ)

Collaborator

Trials

415

Recruited

6,777,000+

Findings from Research

A study involving 38 hospital-based professionals identified multiple hazards to medication safety for older adults during care transitions, highlighting issues such as complex dosing and knowledge gaps in medication management.

The research revealed that medication-related harms stem from both hospital work systems and challenges faced at home, emphasizing the need for improved communication and support for patients and caregivers post-discharge.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Understanding Hazards for Adverse Drug Events Among Older Adults After Hospital Discharge: Insights From Frontline Care Professionals. Xiao, Y., Smith, A., Abebe, E., et al.[2023]

References

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

The effect of a collaborative pharmacist-hospital care transition program on the likelihood of 30-day readmission. [2019]

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

The effect of a pharmacist-led multidisciplinary transitions-of-care pilot for patients at high risk of readmission. [2019]

3. Switzerland pubmed.ncbi.nlm.nih.gov

The Discharge Companion Program: An Interprofessional Collaboration in Transitional Care Model Delivery. [2020]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Pharmacy-supported interventions at transitions of care: an umbrella review. [2020]

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

Impact of an Integrated Pharmacy Transitions of Care Pilot Program in an Urban Hospital. [2017]

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

From the Hospital to Long-Term Care: Protect Vulnerable Patients During Handoff. [2020]

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

Pharmacist-led transitions of care between hospitals, primary care clinics, and community pharmacies. [2022]

8. England pubmed.ncbi.nlm.nih.gov

Evaluation of a transitional care pharmacist intervention in a high-risk cardiovascular patient population. [2019]

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

Understanding Hazards for Adverse Drug Events Among Older Adults After Hospital Discharge: Insights From Frontline Care Professionals. [2023]

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

Pharmacy-Initiated Transitions of Care Services: An Opportunity to Impact Patient Satisfaction. [2019]

11. Netherlands pubmed.ncbi.nlm.nih.gov

Training pharmacy residents as transitions of care specialists: a United States perspective. [2021]

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

Impact of community pharmacist-performed post-discharge medication reviews in transitions of care. [2019]