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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether involving a clinical pharmacist can improve the transition from a hospital to a skilled nursing facility. The goal is to determine if the pharmacist can reduce medication-related problems during this transition. The study includes two groups: one receives assistance from a pharmacist through the Pharmacy Integrated Transitions (PIT) program, while the other follows the usual discharge process. Individuals recently hospitalized at one of several University of Washington medical centers and moving to a participating nursing facility may be suitable candidates, especially if they frequently experience medication changes.

As an unphased trial, this study provides a unique opportunity to enhance medication safety during care transitions.

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 prior data suggests that the Pharmacy Integrated Transitions (PIT) program is safe?

Research has shown that involving pharmacists when patients transition between care settings helps reduce medication errors. These errors can lead to medication-related problems. One study found that pharmacists played a crucial role in enhancing medication safety when patients moved from hospitals to other care facilities. This finding suggests that programs like the Pharmacy Integrated Transitions (PIT) program can enhance patient safety.

No specific safety concerns exist regarding the PIT program itself. The primary goal is to ensure proper medication management during these transitions. This approach aims to prevent harmful events and improve overall patient care. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Pharmacist-Assisted Medication Transition because it offers a hands-on approach to managing patient care during hospital-to-nursing facility transitions. Unlike the standard discharge process, which often leaves gaps in medication management, this program involves a clinical pharmacist who actively reviews and adjusts medications, ensuring a smoother transition. By fostering better communication between hospital and nursing facility teams, this approach aims to reduce medication errors and improve patient outcomes, making it a promising advancement in transitional care.

What evidence suggests that the Pharmacy Integrated Transitions (PIT) program is effective for decreasing medication-related problems during care transitions?

Research has shown that the Pharmacy Integrated Transitions (PIT) program, tested in this trial, helps patients transition more smoothly from hospitals to skilled nursing facilities (SNFs). In this trial, some participants will receive assistance from a clinical pharmacist during their transition, which includes a comprehensive medication review and structured handoff between clinical teams. Studies have found that pharmacist-led medication reviews reduce the chances of patients returning to the hospital and lower their stress by addressing medication safety. Evidence also suggests that these pharmacy services decrease medication-related issues during transitions. Overall, involving pharmacists in the transition from hospitals to SNFs improves patient outcomes. ^{1 2 6 7 8}

Who Is on the Research Team?

Giana Davidson, MD MPH

Principal Investigator

University of Washington

Are You a Good Fit for This Trial?

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

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 being discharged to enter hospice care.

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39740951/

Pharmacy Integrated Transitions (PIT) trial: a protocol for a ... The PIT trial aims to evaluate the effectiveness of the PIT programme in improving patients' care transitions from hospitals to SNFs compared with usual care.

2. bmjopen.bmj.com bmjopen.bmj.com/content/14/12/e088786

a protocol for a pragmatic cluster-randomised crossover trial The PIT trial aims to evaluate the effectiveness of the PIT programme in improving patients' care transitions from hospitals to SNFs compared with usual care.

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11007427/

Effectiveness of pharmacist-led medication reconciliation on ... This pragmatic, prospective, controlled trial evaluated the effectiveness of routine pharmacist-led medication reconciliation compared to standard care on ...

4. digital.ahrq.gov digital.ahrq.gov/2020-year-review/research-summary/improving-care-transitions-hospitalized-patients-pharmacy-integrated-transitions-program

Improving Care Transitions of Hospitalized Patients With the ... The PIT program shows promise to reduce hospital readmissions, lessen patient emotional distress by proactively addressing medication safety.

5. bmcprimcare.biomedcentral.com bmcprimcare.biomedcentral.com/articles/10.1186/s12875-025-02904-z

Effectiveness of digital platform in reducing unintentional ... Conclusions. Medication reconciliation using the MedBook Portal effectively reduces UMDs during the transition of care from hospital discharge ...

6. psnet.ahrq.gov psnet.ahrq.gov/issue/effect-transitional-pharmaceutical-care-program-occurrence-ades-after-discharge-hospital

The effect of a transitional pharmaceutical care program on ... Pharmacists play a critical role in medication safety during transitions of care. This multi-center study found that a transitional pharmacy care program ...

7. pharmacytimes.com pharmacytimes.com/view/pharmacists-strengthen-transitions-of-care-to-improve-patient-outcomes

Pharmacists Strengthen Transitions of Care to Improve ... Pharmacists play an important role in transitions of care by ensuring medication safety and effectiveness during patient movement between care ...

8. outcomes.com outcomes.com/blog/payer/pharmacists-provide-critical-interventions-during-transitions-of-care

Pharmacists Provide Critical Interventions During ... Outcomes receives a notification of a patient's discharge. Outcomes provides an alert within the OutcomesOne platform to notify the pharmacist.