The Effectiveness of Transitional Medication Management on Improving Quality of Life, Medication Adherence, and Reducing Rehospitalization in Older Patients with Heart Failure

Heart failure is common and is one of the common reasons for hospitalization in older adults. Older adults with heart failure need multiple medications which increases the possibility of inappropriate medication management. Inappropriate medication management would be related with adverse drug events (ADEs), heart failure aggravation, poor quality of life, and an increase of acute care service utilization, indicating the critical time to properly manage older heart failure adults' medications during care transitions from hospital discharge to home. Evidence suggested that transitional care provided by nurses would decrease the patients' rehospitalization and cost. However, the effectiveness of transitional medication management provided by nurses during care transitions from hospital discharge to outpatient follow-ups in Taiwan has not been developed. Therefore, the main purposes of this study are to investigate the effectiveness of transitional medication management on increasing the quality of life, enhancing the medication adherence, and decreasing rehospitalization rate within six months following recent hospital discharge among older adults with heart failure. This will be a three-years descriptive experimental longitudinal study. The first year will be the prospective longitudinal design and invite 130 eligible participants. During the second and third year, all study participants will be single-blind randomized divided into experimental and controlled group. The experimental group will receive a 3-months transitional medication management in addition to the routine medication management during care transitions from hospital discharge to outpatient follow-ups. The controlled group will receive routine medication management. Each study participant will have five-times face-to-face interviews to collect data based on study protocol. Potentially inappropriate medications (PIMs) and medication discrepancies (MDs) will be identified by using 2012 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults and comparing the differences of medication lists patient can provide, respectively. Intention-to-treat analysis will be used to minimize the influence of missing outcomes. Descriptive and inferential statistics (t-test, repeated-measure ANOVA) methods will be used to examine the effectiveness of transitional medication management on improving study participants' quality of life, decreasing PIMs and MDs, and decreasing medication-related rehospitalization rate within six months following recent hospital discharge. Logistic regression will be used to investigate the relationship among the hospital, patient, PIMs, and MDs. Results of this study will help clinicians to understand the issues and risk factors associated with potential medication problems during care transitions from hospital discharge to home, in addition to investigate the effectiveness of transitional medication management within 6-months following hospital discharge.