Clinical Trials Logo

Clinical Trial Summary

Adverse drug events (ADEs) are a leading cause of death in North America, with over 2 million ADEs causing 100,000 deaths every year and millions in economic costs. The majority of ADEs that occur within 30 days of discharge from hospital are related to prescription medications and of these, more than 50% are preventable. Among the causes of ADEs are incomplete and unclear medication lists, and a lack of patient understanding and adherence. Patients are usually discharged from hospital on substantially difference medication regiments than those prior to admission. In the absence of supportive mechanisms that ensure patients' understanding of their medication list, adherence to prescribed medication changes is likely to be reduced and the subsequent risk of ADEs increased. Secondary analyses from a recently conducted randomized controlled trial (RCT) by our team suggest that more than 50% of study patient were non-adherent to at least one in-hospital medication change, and that this non-adherence significantly increased the risk of hospital re-admission and emergency department visits in the 30 days post-discharge. Furthermore, analyses of interview data suggest that non-adherence may be driven by unclear communication with patients about medication changes and the reasons for these changes, as well as difficulties in managing complex dosing schedules and drug regimen information. There is therefore a clear need to implement and evaluate patient support mechanisms that reduce non-adherence to essential changes in therapy following hospitalization. The objective of this project is to conduct a pilot RCT that will evaluate the usability of a medication management mobile application and its efficacy in reducing non-adherence to in-hospital medication changes following discharge. We will randomize 100 patients from the internal medicine unit of the McGill University Health Centre (MUHC) Glen site to either the intervention or control arm. Patients in the control arm will receive usual care (i.e. no medication management support), whereas those in the intervention arm will receive a tablet with the installed mobile application. The application will integrate prescription claims data from the Régie de l'assurance maladie du Québec (RAMQ) for the 3-month period prior to hospital admission with the patient's discharge prescription to generate a patient-friendly medication list, along with details of in-hospital medication changes. The app will also offer a number of features designed to maximize patient understanding and adherence, including pill images, patient-friendly drug monographs, weekly dosing schedules, drug alerts, home refill services, and features that connect with the patient's caregiver and hospital pharmacist. At 1 week post-discharge, study coordinators will conduct a usability assessment to obtain patient feedback on the app (via a technology acceptance questionnaire) and to document usability using the "think aloud" protocol, which is based on observing and recording patients as they use the application and verbalize any thoughts that might occur to them. Qualitative analysis of recorded and transcribed sessions will then be used to assess the technology's ease of use, user-friendliness, efficiency, and any features that may cause confusion, frustration, or user errors. Non-adherence to in-hospital treatment changes will be assessed by comparing patients' discharge prescriptions with medications dispensed in the 30 days following hospital discharge (obtained from RAMQ pharmacy claims). We will compare, between intervention and control groups, the average number of in-hospital medication changes not adhered to in the 30-day follow-up period. This project will assess a technological intervention that has the potential to improve patient adherence to in-hospital medication changes and may subsequently reduce the occurrence of ADEs. Given the high costs associated with ADEs, this small investment has the potential to incur significant cost savings for the Quebec healthcare system.


Clinical Trial Description

n/a


Study Design


Related Conditions & MeSH terms


NCT number NCT04676165
Study type Interventional
Source McGill University
Contact
Status Completed
Phase N/A
Start date June 4, 2019
Completion date April 17, 2020

See also
  Status Clinical Trial Phase
Completed NCT04709640 - Pilot Study to Improve Medication Management in Older Adults N/A
Completed NCT03257579 - Myocardial Infarction Prescription Duration Adherence Study N/A
Completed NCT05376397 - Testing THRIVE 365 for Black Sexual Minority Men (On The Daily) N/A
Withdrawn NCT03427008 - A Pilot Study of mDOT for Immunosuppressant Adherence in Adult Kidney Transplant Recipients N/A
Completed NCT03805451 - Life Steps for PrEP for Youth N/A
Withdrawn NCT03292393 - Social Norms and Antihypertensive Medication Adherence N/A
Not yet recruiting NCT02876848 - A Novel E-Health Approach in Optimizing Treatment for Seniors (OPTIMUM Study) N/A
Completed NCT02823795 - The Supporting Patient Activation in Transition to Home Intervention N/A
Completed NCT02914730 - Insulin Dosing Practices in Persons With Diabetes on Multiple Daily Injections
Completed NCT02797262 - Measuring and Monitoring Adherence to ART With Pill Ingestible Sensor System N/A
Completed NCT02066935 - Non-adherence to Immunosuppressives in Kidney Transplantation in Brazil Multicenter Study
Completed NCT01934608 - The Effect of Synching Prescription Refills on Adherence N/A
Completed NCT01741311 - Secondary HIV Prevention and Adherence Among HIV-infected Drug Users N/A
Completed NCT01770314 - Study to Test the Efficacy of Online Education to Increase Safe Use of Opioid Medication. Phase 2
Recruiting NCT01105104 - An Enhanced Medication Monitoring Program Phase 1
Withdrawn NCT01430702 - Feasibility of Using a Telemedicine Medication Delivery Unit for Older Adults N/A
Completed NCT01859273 - Adherence Enhancement for Renal Transplant Patients N/A
Completed NCT01118208 - Blister Packaging Medication to Increase Treatment Adherence and Clinical Response N/A
Completed NCT00848224 - Improving Adherence to Pharmacological Treatment N/A
Completed NCT06034301 - Pill Bottle vs Reminder App N/A