Effect of Medication Management at Home Via Pharmacist-Led Home Televisits: Protocol for a Randomized Controlled Trial (Preprint)

BACKGROUND Older adults are more likely to suffer from multiple chronic conditions, being prescribed multiple medications and are more susceptible to adverse reaction to their medications. In addition, older adults often use over-the-counter medications and supplements, further complicating their medication regimens. Complex medication regimens are potentially harmful to older adults. Interventions aimed at reducing medication discrepancy in the ambulatory clinic setting, such as the review of medication lists, and implementation of “brown bag” reconciliation continues to be challenging with limited success. Pharmacist led interventions to improve appropriate medication use in older adults have demonstrated effectiveness in reducing adverse drug events. In this study NCT04340570, we propose to utilize telemedicine to deliver medication management by pharmacists. Video visits have the potential to provide direct visualization of medications in older adults’ homes, thereby reducing medication discrepancy and increasing medication adherence. Pharmacist-led management of older adults’ medication regimens may improve appropriate medication use in older adults. OBJECTIVE The objective of this study is to examine the effect of a pharmacist-led medication through home televistits compared to usual care on appropriate medication use, medication discrepancies, adherence, and adverse drug events. METHODS We will conduct a 2-site cluster randomized controlled trial NCT04340570. The intervention will be a home televisit by a pharmacist including medication reconciliation and assessment of actual medication use. The cluster randomized controlled trial was iteratively adapted after a pilot test. We will examine outcomes of the pharmacist-led intervention including the primary outcome of medication appropriateness, measured by the STOPP criteria for potentially inappropriate medications at 6 months. Medication lists obtained will be compared against the medical record by a clinician reviewer to establish discrepancies in medications. The clinician will review medications using the validated Medication Appropriateness Index (MAI). RESULTS This project has been peer reviewed and selected for support by the VA Health Services Research Service. We anticipate the completion of the ongoing trial in Spring 2025. The first results are expected to be submitted for publication in 2025. CONCLUSIONS The cluster randomized clinical trial will provide evidence on medication management through televisits. If found to be effective in improving the use of medications, the intervention has the potential to impact oClinicalTrials.gov NCT04340570lder adults with multiple chronic conditions and polypharmacy. CLINICALTRIAL ClinicalTrials.gov NCT04340570