Coordination of oral anticoagulant care at hospital discharge (COACHeD): pilot randomised controlled trial
Lehana Thabane,
Jean-Eric Tarride,
James Douketis,
Sam Schulman,
Anne Holbrook,
Deborah Siegal,
Jiawen Deng,
Sue Troyan,
Sylvia Hyland,
Amna Ahmed,
Victoria Telford,
Yousery Koubaesh,
Kristina Vidug,
Lindsay Yoo,
Simran Lohit,
Stephen Giilck,
Marianne Talman,
Blair Leonard,
Mohammad Refaei,
Joanne Man-Wai Ho
Affiliations
Lehana Thabane
12 Biotatistics Unit, Research Institute of St. Joes Hamilton, Hamilton, Ontario, Canada
Jean-Eric Tarride
Department of Health Research Methods, Evidence, and Impact (HEI), Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Ontario, Canada
James Douketis
4 Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Sam Schulman
7 Department of Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
Anne Holbrook
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
Deborah Siegal
17 Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
Jiawen Deng
2 Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, Ontario, Canada
Sue Troyan
2 Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, Ontario, Canada
Sylvia Hyland
14 Institute for Safe Medication Practices Canada, North York, Ontario, Canada
Amna Ahmed
4 Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Victoria Telford
2 Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, Ontario, Canada
Yousery Koubaesh
4 Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Kristina Vidug
2 Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, Ontario, Canada
Lindsay Yoo
2 Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, Ontario, Canada
Simran Lohit
2 Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, Ontario, Canada
Stephen Giilck
4 Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Marianne Talman
4 Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Blair Leonard
8 Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Mohammad Refaei
9 Department of Medicine, Niagara Health System, St. Catharines, Ontario, Canada
Joanne Man-Wai Ho
15 Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
Objectives To evaluate whether a focused, expert medication management intervention is feasible and potentially effective in preventing anticoagulation-related adverse events for patients transitioning from hospital to home.Design Randomised, parallel design.Setting Medical wards at six hospital sites in southern Ontario, Canada.Participants Adults 18 years of age or older being discharged to home on an oral anticoagulant (OAC) to be taken for at least 4 weeks.Interventions Clinical pharmacologist-led intervention, including a detailed discharge medication management plan, a circle of care handover and early postdischarge virtual check-up visits to 1 month with 3-month follow-up. The control group received the usual care.Outcomes measures Primary outcomes were study feasibility outcomes (recruitment, retention and cost per patient). Secondary outcomes included adverse anticoagulant safety events composite, quality of transitional care, quality of life, anticoagulant knowledge, satisfaction with care, problems with medications and health resource utilisation.Results Extensive periods of restriction of recruitment plus difficulties accessing patients at the time of discharge negatively impacted feasibility, especially cost per patient recruited. Of 845 patients screened, 167 were eligible and 56 were randomised. The mean age (±SD) was 71.2±12.5 years, 42.9% females, with two lost to follow-up. Intervention patients were more likely to rate their ability to manage their OAC as improved (17/27 (63.0%) vs 7/22 (31.8%), OR 3.6 (95% CI 1.1 to 12.0)) and their continuity of care as improved (21/27 (77.8%) vs 2/22 (9.1%), OR 35.0 (95% CI 6.3 to 194.2)). Fewer intervention patients were taking one or more inappropriate medications (7 (22.5%) vs 15 (60%), OR 0.19 (95% CI 0.06 to 0.62)).Conclusion This pilot randomised controlled trial suggests that a transitional care intervention at hospital discharge for older adults taking OACs was well received and potentially effective for some surrogate outcomes, but overly costly to proceed to a definitive large trial.Trial registration number NCT02777047.