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

项目摘要/摘要 患有多种慢性病的社会经济弱势人群有较高的 出院后不坚持服用基本的慢性病药物。用药不依从 出院后与死亡率和再住院率显著相关 以及这些患者的费用。主要患者-报告的出院后基本药物使用障碍 低收入个人的排放与健康的社会决定因素(SDOH)有关，包括：1) 经济障碍(即买不起药)，2)交通障碍(即无法获得 处方药或需要的后续护理)，以及3)系统层面的障碍(即缺乏 出院药物和护理协调服务，以确保快速的初级保健后续行动)。虽然， 药物治疗管理和药物调节服务在护理过渡期间很重要， 事实证明，这些服务在改善出院后的服药依从性方面并不有效， 强调迫切需要创新的干预措施。我们的初步研究证明了这一点的可行性和 提高成人医疗补助和未参保住院患者的服药依从性的潜力 药物补贴和/或在护理期间和之后的床边和随后的药物递送到家 过渡。此外，我们之前的研究发现，来自受过培训的认证药房技术人员的支持 教练有效地增加了出院后快速的初级保健跟进，并可以改善 药物依从性。然而，直接涉及可负担性、可获得性、 而且，改善弱势人群出院后服药依从性的有效性仍不清楚。 医疗过渡期的药物可负担性、可获得性和可获得性(MED AAAction)研究 将测试药房主导的护理过渡干预相对于常规护理的有效性 388例医疗补助和未参保MCC住院患者的实用随机对照试验 田纳西州的大型医疗系统。干预将包括：1)零共付率的药物，2) 床边送药，然后上门送药，以及3)由注册药房提供护理协调 技术人员/健康教练协助获得药物和快速初级保健后续服务。我们将研究 干预12个月对1)服药依从性(主要结果)和2)快速的影响 初级保健随访、30天再入院、住院和急诊科就诊以及费用。我们 将进行关键的信息提供人面谈，以了解患者在治疗过程中和治疗后的经验 护理过渡。通过检查干预对结果的有效性，包括服药依从性， 这项研究将为卫生系统提供有价值的结果， 付款人和政策制定者协助今后的实施和干预措施的可持续性 社会经济上处于不利地位的人群。

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.