Pharmacy-led Transitions of Care Intervention to Address System-Level Barriers and Improve Medication Adherence in Socioeconomically Disadvantaged Populations

药房主导的护理干预转型，以解决系统层面的障碍并提高社会经济弱势群体的药物依从性

基本信息

批准号：
10594350
负责人：
Satya Surbhi
金额：
$ 74.15万
依托单位：
UNIVERSITY OF TENNESSEE HEALTH SCI CTR
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-06 至 2028-01-31
项目状态：
未结题

项目摘要

PROJECT SUMMARY/ABSTRACT Socioeconomically disadvantaged populations with multiple chronic conditions have high rates of nonadherence to essential chronic disease medications after hospital discharge. Medication nonadherence after hospital discharge is significantly associated with increased mortality and higher rates of readmissions and costs among these patients. Major patient-reported barriers to essential medication use after hospital discharge among low-income individuals are related to social determinants of health (SDOH) and include: 1) financial barriers (i.e. inability to afford medications), 2) transportation barriers (i.e. inability to access prescribed medications or needed follow-up care), and 3) system-level barriers (i.e. lack of availability of discharge medications and care coordination services to ensure rapid primary care follow-up). Although, medication therapy management and medication reconciliation services are important during care transitions, these services have not proven effective in improving medication adherence after hospital discharge, highlighting a critical need for innovative interventions. Our pilot study has demonstrated the feasibility and potential to improve medication adherence among adult Medicaid and uninsured inpatients through full medication subsidy and/or bedside and subsequent home delivery of medications during and after care transitions. Moreover, our previous research found that support from certified pharmacy technicians trained as coaches effectively increases rapid primary care follow-up after hospital discharge and could improve medication adherence. Yet the effectiveness of interventions that directly address affordability, accessibility, and availability to improve post-discharge medication adherence in vulnerable populations is still unknown. The Medication Affordability, Accessibility, and Availability in Care Transitions (Med AAAction) Study will test the effectiveness of a pharmacy-led care transitions intervention versus usual care through a pragmatic randomized controlled trial of 388 Medicaid and uninsured hospital in-patients with MCC from three large healthcare systems in Tennessee. The intervention will involve: 1) medications with zero copay, 2) bedside delivery then home delivery of medications, and 3) care coordination provided by certified pharmacy technicians/health coaches to assist with medication access and rapid primary care follow-up. We will examine the impact of the intervention during 12 months on 1) medication adherence (primary outcome) and 2) rapid primary care follow-up, 30-day readmissions, hospitalizations and emergency department visits, and costs. We will conduct key informant interviews to understand patient experience with the acre received during and after care transitions. By examining effectiveness of the intervention on outcomes including medication adherence, health care utilization, costs, and patient experience, this study will provide valuable results to health systems, payers, and policymakers to assist in future implementation and sustainability of the intervention for socioeconomically disadvantaged populations.

项目摘要/摘要具有多种慢性条件的社会经济弱势群体的率很高出院后必需的慢性疾病药物不依赖。药物不遵守住院后，出院后与死亡率的增加显着相关和更高的再入院率这些患者的成本。医院后的主要患者报告的主要用药障碍低收入个人之间的出院与健康的社会决定因素（SDOH）有关，包括：1）财务障碍（即无法负担药物），2）运输障碍（即无法进入规定药物或需要的后续护理）和3）系统级障碍（即缺乏可用性排放药物和护理协调服务，以确保快速初级保健随访）。虽然，药物治疗管理和药物对帐服务在护理过渡期间很重要，这些服务尚未证明有效地改善了住院后的药物依从性，强调对创新干预措施的迫切需求。我们的试点研究证明了可行性和通过充分的药物补贴和/或床边以及随后在护理期间和之后的药物交付过渡。此外，我们以前的研究发现，经过认证的药房技术人员的支持教练有效地增加了住院后快速的初级保健随访，并且可以改善药物依从性。然而，直接解决可负担性，可访问性的干预措施的有效性，以及改善弱势群体中的入院后药物依从性的可用性尚不清楚。药物负担能力，可访问性和护理过渡中的可用性（MED AAACTION）研究将测试由药房主导的护理过渡干预的有效性与通过 388个医疗补助和未投保医院住院患者的务实随机对照试验与三个田纳西州的大型医疗系统。干预措施将涉及：1）零COPAY的药物，2）床头交货然后提供药物的送货服务，3）由认证药房提供的护理协调技术人员/健康教练协助药物访问和快速初级保健随访。我们将检查 12个月内干预措施对1）药物依从性（主要结果）和2）快速初级保健随访，30天的再入院，住院和急诊室就诊以及费用。我们将进行关键的线人访谈，以了解患者在收到和之后收到的英亩的患者体验护理过渡。通过检查干预措施的有效性，包括药物依从性，卫生保健利用，成本和患者经验，本研究将为卫生系统提供宝贵的结果，付款人和政策制定者协助未来的实施和可持续性社会经济处于弱势群体。