Discharge Planning for Elderly Patients in the Emergency Department: Use of a Brief Phone Call After Discharge to Improve Medication Utilization and Physician Follow-up

The investigators hypothesize that the acquisition and correct utilization of medications as well as arranging and attending follow-up appointments will improve as a result of a phone call intervention 1-3 days after elderly patients are discharged from the emergency department (ED).

Study Overview

• Status: Completed
• Conditions: Patient Discharge
• Intervention / Treatment: Other: Phone call follow-up; Other: Satisfaction survey; Other: Control group --- no intervention

Detailed Description

Older patients seen in the ED are at high risk of functional decline and return visits to the ED. Previous studies have shown that a comprehensive assessment by a geriatric specialist at the time of discharge from the ED along with extensive integration with home services and/or referral to community services can decrease functional decline and return visits to the ED as well as increase patient satisfaction, but this intervention is resource intensive requiring a geriatric discharge specialist to be available to the emergency department 24 hours a day/ 7 days a week. It is also known that in other patient populations telephone reminders to make follow up appointments can increase rate of follow up and that comprehension of discharge instructions is the primary barrier to compliance with discharge instructions. It has been shown that telephone follow-up interviews are feasible for geriatric patients discharged from the ED, and that many elderly patients discharged from the ED do not understand their discharge instructions or attend follow-up appointments. However, there are no published studies evaluating whether a follow up telephone call after discharge from the ED can improve patient compliance with the medical treatment plan including obtaining follow - up appointments and obtaining prescribed medications as well as using them appropriately. We seek to determine if we can increase compliance with medications and outpatient follow up with a phone call from a nurse provider 1-3 days after discharge.

• Study Type: Interventional
• Enrollment (Actual): 157
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Chapel Hill, North Carolina, United States, 27599
      • University of North Carolina Emergency Department

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 63 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Age 65 or over
• Discharged from the UNC emergency department

Exclusion Criteria:

• In the hospital at the time of phone call follow-up
• Neither the patient nor their responsible party are able to pass a standardized test to assess cognitive function

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Follow-up phone call from Nurse; Patients in this are will receive a phone call follow-up from a nurse 1-3 days after their discharge from the ED.	Other: Phone call follow-up; A nurse will call the patient to counsel patients on their medications and following up with their primary care provider.
Placebo Comparator: Satisfaction survey; This group of patients will receive a phone call from a student who will conduct a brief satisfaction survey of the patient's experience in the ED.	Other: Satisfaction survey; Patients will be given a satisfaction survey.
Placebo Comparator: Control group; Patients in this group will receive no phone call at 1-3 days.	Other: Control group --- no intervention; Control group

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Whether patient obtained medications prescribed at their discharge from ED	5-8 days after discharge from ED
Whether patient is using medications that were prescribed at their ED discharge correctly	5-8 days after discharge from ED
Whether the patient arranged a follow-up appointment with their primary care provider	5-8 days after discharge from ED
Whether patient attended visit with their primary care provider after discharge from the ED	30-35 days after discharge from ED

Secondary Outcome Measures

Outcome Measure	Time Frame
Patient's satisfaction with ED visit	5-8 days after discharge from the ED
Return to the ED within 30 days of initial visit	30-35 days after discharge from ED
Cost of the intervention	35 days after last patient enrolled

Collaborators and Investigators

• Sponsor: University of North Carolina, Chapel Hill
• Collaborators: The Duke Endowment
• Investigators: Principal Investigator: Kevin J Biese, MD, University of North Carolina, Chapel Hill

Publications and helpful links

General Publications

• Biese K, Lamantia M, Shofer F, McCall B, Roberts E, Stearns SC, Principe S, Kizer JS, Cairns CB, Busby-Whitehead J. A randomized trial exploring the effect of a telephone call follow-up on care plan compliance among older adults discharged home from the emergency department. Acad Emerg Med. 2014 Feb;21(2):188-95. doi: 10.1111/acem.12308.

Study record dates

Study Major Dates

• Study Start: September 1, 2010
• Primary Completion (Actual): November 1, 2010
• Study Completion (Actual): November 1, 2010

Study Registration Dates

• First Submitted: September 13, 2010
• First Submitted That Met QC Criteria: September 21, 2010
• First Posted (Estimate): September 22, 2010

Study Record Updates

• Last Update Posted (Estimate): November 18, 2011
• Last Update Submitted That Met QC Criteria: November 17, 2011
• Last Verified: November 1, 2011

More Information

Terms related to this study

• Keywords: emergency medicine; primary care physicians
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 10-0978