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

项目总结/摘要 患有多种慢性病的社会经济弱势群体的 出院后不坚持基本的慢性病药物治疗。药物不依从 出院后死亡率和再入院率显著增加 这些患者的成本。患者报告的住院后使用基本药物的主要障碍 低收入人群的出院率与健康的社会决定因素（SDOH）有关，包括：1） 经济障碍（即无力负担药物），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（即缺乏可用的 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）。不过，虽然 药物治疗管理和药物调节服务在护理过渡期间是重要的， 这些服务在改善出院后的药物依从性方面没有被证明是有效的， 强调迫切需要创新的干预措施。我们的试点研究证明了可行性， 通过全面的医疗保险计划，有可能提高成年医疗补助和无保险住院患者的药物依从性 医疗补贴和/或护理期间和护理后的床边和随后的家庭药物交付 过渡。此外，我们以前的研究发现，来自经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的快速初级保健随访， 药物依从性。然而，直接解决可负担性、可获得性、 改善弱势群体出院后服药依从性的可行性仍然未知。 医疗过渡中的药物负担能力、可及性和可用性（Med AAAction）研究 将通过一项研究来测试以药房为主导的护理过渡干预与常规护理的有效性， 388名医疗补助和无保险的MCC住院患者的一项实用的随机对照试验， 田纳西州的大型医疗系统。干预将包括：1）零共付额的药物，2） 床边交付，然后将药物送至家中，以及3）由认证药房提供的护理协调 技术员/保健教练协助获得药物和快速初级保健后续行动。我们将研究 12个月期间干预对1）药物依从性（主要结局）和2）快速 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 我将进行关键的线人访谈，以了解患者的经验与英亩期间和之后收到的 护理过渡通过检查干预措施对包括药物依从性在内的结果的有效性， 卫生保健利用率、成本和患者体验，这项研究将为卫生系统提供有价值的结果， 支付者和政策制定者，以协助未来的实施和干预的可持续性， 社会经济弱势群体。

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.