A Randomized, Controlled Pragmatic Trial of Telephonic Medication Therapy Management to Reduce Hospitalization in Home Health Patients. (9th April 2014)

• Record Type: Journal Article
• Authors: Zillich, Alan J.; Snyder, Margie E.; Frail, Caitlin K.; Lewis, Julie L.; Deshotels, Donny; Dunham, Patrick; Jaynes, Heather A.; Sutherland, Jason M.
• Is Part Of: Health services research. Volume 49:Number 5(2014)
• Page Start: 1537
• Page End: 1554
• Publication Date: 2014-04-09
• Subjects: Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.12176
• Languages: English
• ISSNs: 0017-9124

Abstract

<abstract abstract-type="main" id="hesr12176-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hesr12176-sec-0001" sec-type="section"> <title>Objective</title> <p>To evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing hospitalizations among home health patients.</p> </sec> <sec id="hesr12176-sec-0002" sec-type="section"> <title>Setting</title> <p>Forty randomly selected, geographically diverse home health care centers in the United States.</p> </sec> <sec id="hesr12176-sec-0003" sec-type="section"> <title>Design</title> <p>Two‐stage, randomized, controlled trial with 60‐day follow‐up. All Medicare‐ insured home health care patients were eligible to participate. Twenty‐eight consecutive patients within each care center were recruited and randomized to usual care or MTM intervention. The MTM intervention consisted of the following: (1) initial phone call by a pharmacy technician to verify active medications; (2) pharmacist‐provided medication regimen review by telephone; and (3) follow‐up pharmacist phone calls at day seven and as needed for 30 days. The primary outcome was 60‐day all‐cause hospitalization.</p> </sec> <sec id="hesr12176-sec-0004" sec-type="section"> <title>Data Collection</title> <p>Data were collected from in‐home nursing assessments using the OASIS‐C. Multivariate logistic regression modeled the effect of the MTM intervention on the probability of hospitalization while adjusting for patients' baseline risk of hospitalization, number of medications taken daily, and other OASIS‐C data elements.</p> </sec> <sec id="hesr12176-sec-0005" sec-type="section"> <title>Principal Findings</title> <p>A total of 895 patients (intervention <italic>n</italic> = 415, control <italic>n</italic> = 480) were block‐randomized to the intervention or usual care. There was no significant difference in the 60‐day probability of hospitalization between the MTM intervention and control groups (Adjusted OR: 1.26, 95 percent CI: 0.89–1.77, <italic>p</italic> = .19). For patients within the lowest baseline risk quartile (<italic>n</italic> = 232), the intervention group was three times more likely to remain out of the hospital at 60 days (Adjusted OR: 3.79, 95 percent CI: 1.35–10.57, <italic>p</italic> = .01) compared to the usual care group.</p> </sec> <sec id="hesr12176-sec-0006" sec-type="section"> <title>Conclusions</title> <p>This MTM intervention may not be effective for all home health patients; however, for those patients with the lowest‐risk profile, the MTM intervention prevented patients from being hospitalized at 60 days.</p> </sec> </abstract>