Grant: Operating Grant

One of the most common health care interventions in any healthcare setting is a medication prescription. Unfortunately, up to 25% of outpatient prescriptions are associated with adverse drug events (ADEs). ADEs decrease patient health directly and can lead to non-adherence, which in turn have negative consequences. We have recently conducted a pilot project in which we tested the feasibility and potential utility of an information technology enabled outreach program for monitoring patients receiving and outpatient prescription. This intervention involved the use of an interactive voice response system programmed to automatically call ambulatory care patients following a prescription. If the system identified a potential medication problem, then a pharmacist was notified who subsequently contacted the patient, modified the therapy accordingly, and informed a physician when necessary. Our pilot project included 568 patients with diverse illnesses in two Canadian cities. On 21-day interviews we determinedhigh levels of patient and provider acceptability of the system. The program identified 56 of 125 (45%) ADEs and 10 of 26 30%) of primary non-compliance events. We observed very few episodes of ameliorable ADEs. These events were more common in a previous study of outpatient ADEs. We feel these results justify a randomized control trial to assess the effectiveness of our intervention for improving patient -centered outcomes. We plan to randomize ambulatory care patients receiving incident prescriptions for one of four conditions (hypertension, diabetes mellitus, depression, and anxiety) to our intervention versus routine care to determine whether the system reduces the severity and duration of outpatient ADEs and improves adherence to medication care atthree and 12 months. This study will provide important information to guide future applications of our approach beyond the specific question asked in this protocol.