Optimizing Prescribing Decisions for Hospitalized Older Adults With Chronic Conditions

Official title

Optimizing Prescribing Decisions for Hospitalized Older Adults With Chronic Conditions: Aim 3

Overview

The goal of this pilot clinical trial is to learn if providing a clinical decision framework for managing older adults chronic conditions during hospitalization to inpatient clinicians improves clinicians' ability to individualize chronic condition prescribing decisions for hospitalized older adults (65 and older). The main questions it aims to answer are: * Will the clinical decision framework lead to clinicians having greater confidence to individualize discharge prescribing? * Will clinicians using the framework discharge make fewer changes to hospitalized older adults with home diabetes and hypertension medications than they did prior to receiving the framework? * Will older adult patients of participating clinicians will report fewer gaps in understanding of medication changes after the clinician is exposed to the framework? Researchers will compare participating clinician survey responses and prescribing records from before and after an educational session presenting the clinical decision framework. Participants will be asked to * Attend a one-time educational session on the clinical decision framework * Complete 2 electronic surveys, one before and one following the educational session. * Agree for researchers to contact their patients, in order for patients to complete a one-time phone survey about changes made to home medications during hospitalization and quality of communication from the hospital team.

Interventions

• Other Clinical Decision Framework for Managing older adults' chronic conditions during hospitalization.
  All clinicians will attend an educational session where they will be provided a clinical decision framework for management of chronic conditions in hospitalized older adults, reviewing guiding principles for managing chronic disease in the hospital, and working through case-based hypothetical examples.

Primary outcome measures

• Clinician - Change in Prescribing Self-Efficacy [Time frame: Baseline and three months post-intervention]

Secondary outcome measures (12)

• Clinician - Change in Attitudes [Time frame: Baseline and three months post-intervention]
• Clinician - Discharge Prescribing [Time frame: Pre-intervention and post-intervention (2 months before and 3 months after the intervention)]
• Patient - Change in Medication Discrepencies [Time frame: Single time survey within a week of discharge from clinician participants care.]
• Clinician - Acceptability of Clinical Decision Framework [Time frame: 3 months post-intervention]
• Clinician - Change in Intentions [Time frame: Baseline and three months post-intervention]
• Clinician - Change in Perceived Norms [Time frame: Baseline and three months post-intervention]
• Clinician - Awareness of Evidence Base [Time frame: Baseline and three months post-intervention]
• Patient - Change in Overall Hospital Experience [Time frame: Baseline and three months post-intervention]
• Patient - Change in Experience in the Hospital [Time frame: Baseline and three months post-intervention]
• Patient - Change in Experience Leaving the Hospital [Time frame: Baseline and three months post-intervention]
• Patient - Change in Understanding of Medication Changes [Time frame: Baseline and three months post-intervention]
• Patient - Change in Comprehension of Disease Monitoring [Time frame: Baseline and three months post-intervention]

Eligibility criteria

Clinician Participants:

Inclusion criteria

• Attending clinicians who practice on the general medicine or hospital medicine service at UPMC Presbyterian, UPMC Montefiore, UPMC Shadyside, UPMC Mercy, or UPMC Magee-Women's Hospital campuses.
• Practicing on the general medicine or hospital medicine service. This population may include physicians with training in general internal medicine, hospital medicine, family practice, internal medicine subspecialities, as well as advance practice clinicians.

Exclusion criteria

• Anticipating leaving current clinical position within next 3 months
• Less than 4 weeks of inpatient attending service scheduled within 3 months of recruitment

Patient Participants:

Inclusion criteria

• Adult aged 65 years or older who are hospitalized under the care of a participating clinician and discharged home.
• Eligible patients must recieve at least one cardiometabolic medication change at hospital discharge (can include new medication starts, stops, or dose changes). Cardiometabolic medications include any class of antihypertensive, lipid lowering, anti-platelet, or glucose lowering medications regardless of indication for use.

Exclusion criteria

• Incapacity for informed consent / unable to answer survey questions due to cognitive impairment
• Enrolled in hospice care

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Health services research

Study locations

United States · 1 center

• University of Pittsburgh — Pittsburgh

Identifiers

NCT: NCT06605807 · STUDY24070027 · K76AG074878

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗