Abstract
Objectives To evaluate whether a focused, expert
medication management intervention is feasible and
potentially effective in preventing anticoagulation-related
adverse events for patients transitioning from hospital to
home.
Design Randomised, parallel design.
Setting Medical wards at six hospital sites in southern
Ontario, Canada.
Participants Adults 18 years of age or older being
discharged to home on an oral anticoagulant (OAC) to be
taken for at least 4 weeks.
Interventions Clinical pharmacologist-led
intervention,
including a detailed discharge medication management
plan, a circle of care handover and early postdischarge
virtual check-up
visits to 1 month with 3-month
follow-up.
The control group received the usual care.
Outcomes measures Primary outcomes were study
feasibility outcomes (recruitment, retention and cost
per patient). Secondary outcomes included adverse
anticoagulant safety events composite, quality of
transitional care, quality of life, anticoagulant knowledge,
satisfaction with care, problems with medications and
health resource utilisation.
Results Extensive periods of restriction of recruitment
plus difficulties accessing patients at the time of discharge
negatively impacted feasibility, especially cost per patient
recruited. Of 845 patients screened, 167 were eligible and
56 were randomised. The mean age (±SD) was 71.2±12.5
years, 42.9% females, with two lost to follow-up.
Intervention patients were more likely to rate their ability
to manage their OAC as improved (17/27 (63.0%) vs 7/22
(31.8%), OR 3.6 (95% CI 1.1 to 12.0)) and their continuity
of care as improved (21/27 (77.8%) vs 2/22 (9.1%), OR
35.0 (95% CI 6.3 to 194.2)). Fewer intervention patients
were taking one or more inappropriate medications (7
(22.5%) vs 15 (60%), OR 0.19 (95% CI 0.06 to 0.62)).
Conclusion This pilot randomised controlled trial
suggests that a transitional care intervention at hospital
discharge for older adults taking OACs was well received
and potentially effective for some surrogate outcomes, but
overly costly to proceed to a definitive large trial.