The Iowa Continuity of Care study: Background and methods

Abstract

Purpose: The background and methods of an ongoing study to determine the effects of hospital pharmacists' enhanced communication with patients and their community providers are described.

Summary: The Iowa Continuity of Care study is a randomized, prospective trial enrolling 1000 patients with selected medical conditions admitted to one large Midwest hospital. Patients will be randomized to a control group (usual care), minimal intervention, or enhanced intervention. For the intervention groups, a pharmacist case manager (PCM) will provide admission medication verification with the patients' community pharmacists, medication teaching, and discharge counseling. Patients in the enhanced intervention group will have a discharge care plan faxed to their outpatient physician and community pharmacist and will receive a follow-up phone call from the PCM three to five days after discharge; the PCM will continue to facilitate communication between the patient and community providers until all medication problems are resolved. A blinded research nurse will collect data, including adverse drug event (ADE) data, at admission and 30 and 90 days after discharge. The primary outcome measures include medication appropriateness, ADEs, emergency department visits, unscheduled office visits, and rehospitalizations. Data will be collected from the inpatient electronic medical record, outpatient physician medical records, and community pharmacist records and directly from patients. A cost-effectiveness analysis will be performed.

Conclusion: This study will address the value of a PCM in improving communication of care plans between the inpatient and community settings and thereby optimizing medication use.

Figure 1

Overall study design. UIHC = University of Iowa Hospitals and Clinics, ADE = adverse drug event.