Optimizing Prescribing Decisions for Hospitalized Older Adults With Chronic Conditions
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorUniversity of Pittsburgh
About this trial
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.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
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.
Disqualifiers
Anticipating leaving current clinical position within next 3 months
Less than 4 weeks of inpatient attending service scheduled within 3 months of recruitment
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.
Trial design
Design model
Single group
Treatments tested in this trial
Clinical Decision Framework for Managing older adults' chronic conditions during hospitalization.
Other interventionAll 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.
Treatment groups
150 Participants
are divided into 1 treatment groupGroup A: Clinician ParticipantsExperimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
Clinician - Change in Prescribing Self-Efficacy
For each clinician participant the investigators will ask their self-efficacy to individualize blood pressure and diabetes treatment decisions for hospitalized older adults. Measured through ten 7-point Likert scale questions measured \[Strongly Disagree - Strongly Agree\]. Scores will be summed and range from 10 (all Strongly Disagree) to 70 (all Strongly Agree).
Time frame
Baseline and three months post-interventionSecondary outcomes
1
Clinician - Change in Attitudes
The investigators will ask clinicians 8 questions about their attitudes towards individualizing antihypertensive and diabetes treatment decisions on a 7-point Likert scale. Individualizing antihypertensive and diabetes treatment decisions for hospitalized older adults is: Necessary - Unnecessary Beneficial - Harmful High-priority - Low-priority Worthless - Useful. Scores will be summed and range from 8 to 56.
Time frame
Baseline and three months post-intervention2
Clinician - Discharge Prescribing
For each clinician participant, the investigators will review the electronic health record for all hospitalized patients aged 65 years and older who were discharged alive under the clinician participant's care in the 2 months before and 3 months after the intervention to identify all antihypertensive and diabetes medication changes made during hospitalization. The investigators will compare the proportion of patients discharged with cardiometabolic medication changes in the 2 months prior to the intervention to the 3 months after the intervention. The investigators will examine proportion of patients receiving medication intensifications and the proportion receiving any medication change.
Time frame
Pre-intervention and post-intervention (2 months before and 3 months after the intervention)3
Patient - Change in Medication Discrepencies
The investigators will ask each enrolled patient how they are taking each of their cardiometabolic medications and compare their current reported medication use to the hospital discharge summary. The investigators will compare the proportion of patient participants reported a medication discrepancy (taking medication differently than hospital discharge summary) in the pre-intervention period to the post-intervention period.
Time frame
Single time survey within a week of discharge from clinician participants care.4
Clinician - Acceptability of Clinical Decision Framework
The investigators will ask clinicians if they used the clinical decision framework and 7 questions on a 7 point Likert scale (strongly disagree to strongly agree) regarding the framework's clarity, length, and whether it was useful. The investigators will ask what they liked about the framework and what would they change. The investigators will ask about facilitators and barriers to using the framework and whether they plan to keep using it. Scores will be summed and range from 7 to 49.
Time frame
3 months post-interventionSponsors and contacts
Click on the lead sponsor to view all of their trials.
University of Pittsburgh
Lead sponsor
National Institute on Aging (NIA)
Collaborator
Source ClinicalTrials.gov