- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04068727
LEAVE Safe With DOACs
February 15, 2024 updated by: Alok Kapoor, University of Massachusetts, Worcester
Leveraging Evidence-based Practices for Ambulatory VTE and Other Patients to be Safe With Direct Oral Anticoagulants: LEAVE Safe With DOACs
Given the risks associated with direct oral anticoagulants (DOACs) and the lack of defined pathways for patients prescribed this class of medications, the study intervention has the potential for an enormous impact in preventing medication errors and improving the quality of care transition, patient knowledge, and adherence with DOAC therapy.
Study Overview
Status
Completed
Intervention / Treatment
Detailed Description
Patients first treated with direct oral anticoagulants (DOACs) in an ambulatory setting are at an elevated risk for adverse drug events (ADEs) or potential ADEs from medication errors.
An intervention that integrates clinical pharmacists, a pharmacy technician, and follows a checklist published by experts at the Anticoagulation Forum can prevent adverse outcomes.
The Investigators propose research on the effectiveness, implementation, and dissemination for a care transition intervention that follows the checklist which includes evaluation for appropriateness of DOAC use, assistance with drug procurement, telephone access to an anticoagulation expert, and other best practice recommendations.
Study Type
Interventional
Enrollment (Actual)
561
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Massachusetts
-
Worcester, Massachusetts, United States, 01605
- UMASS Memorial Medical Center
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Age ≥ 18
- New prescription of DOAC within 4 days of consent OR continued DOAC use for a patient with new episode of worsening thromboembolic or bleeding event within 4 days of consent or discharged from the hospital with DOAC prescription within 4 days of consent
- Fluency in English, Portuguese, or Spanish
Exclusion Criteria:
- Currently hospitalized with inpatient status (as opposed to observation status)
- Age < 18
- Prisoners
- Pregnant patients (medications are contraindicated)
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control
|
|
Experimental: Clinical Pharmacist Intervention
|
After randomization, the pharmacist calls patients to assess drug choice and dose.
Staff distribute manufacturer coupons and help patients apply for medication payment assistance.
Pharmacist discusses DOAC alternatives with prescribe and provides DOAC education by discussing potential adverse effects, medication interactions, alarm symptoms, and lab work.
Staff mail educational materials.
Pharmacist documents concerns in the electronic health record and messages prescriber about missing lab work.
Patients share medication-related concerns.
Patients are provided with a phone number for non-education calls to discuss their medications from 6 AM - 10 PM on any day.
The pharmacist offers dose de-escalation instructions based on the DOAC prescription.
The pharmacist advises the continuity provider on DOAC duration and monitoring.
For follow-up/perioperative support, the pharmacist reviews and recommends lab monitoring and gives DOAC interruption/resumption recommendations.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Direct Oral Anticoagulant (DOAC)-Related Clinically Important Medication Errors
Time Frame: 90 Days Post Enrollment
|
The number of preventable, ameliorable and potential Adverse Drug Events (ADEs) that physician reviewers attribute to Direct Oral Anticoagulant (DOAC) medication.
Each DOAC related clinically important medication error is counted as a separate event, enabling patients to have multiple events consistent with the literature.
|
90 Days Post Enrollment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient Knowledge regarding Anticoagulation and Venus Thromboembolism (VTE) using the Anticoagulation and Venus Thromboembolism (VTE) knowledge questionnaire
Time Frame: 90 Days Post Enrollment
|
Patient knowledge regarding Anticoagulation and Venus Thromboembolism (VTE) will be evaluated using a modified version of a 22-item instrument previously developed and tested by the institution.
This instrument assesses patients' knowledge of warning signs of bleeding and new VTE, interactions with other medications, and complications of VTE.
A low score indicate a low level of knowledge and a high score indicates a high level of knowledge regarding anticoagulation and VTE.
|
90 Days Post Enrollment
|
Number of missed or extra doses to assess medication adherence
Time Frame: 90 Days Post Enrollment
|
Patients are asked to to count out the number of remaining pills from the last filled prescription and provide the fill date, number of pills dispensed, the schedule prescribed (either once or twice a day depending on DOAC), and skipped doses for deliberate interruption to determine medication adherence with the number of missed or extra doses.
|
90 Days Post Enrollment
|
Medication Possession Ratio (MPR) to assess medication adherence
Time Frame: 90 Days Post Enrollment
|
Medication adherence is measured with Medication Possession Ratio (MPR) which is the ratio between the time a patient had medication on hand, the time that a patient is eligible to have a medication on hand, and the time that a patient is covered by the medication.
The MPR ratio will be calculated by using available pharmacy data.
|
90 Days Post Enrollment
|
Proportion of days covered (PDC) to assess medication adherence
Time Frame: 90 Days Post Enrollment
|
Proportion of Days Covered (PDC) is the ratio between the time that a patient has a medication on hand, the time that a patient is eligible to have a medication on hand, and the time that a patient is covered by the medication.
Medication adherence will be evaluated using the mean PDC using available pharmacy data.
|
90 Days Post Enrollment
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Alok Kapoor, MD, UMass Medical School
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
December 2, 2019
Primary Completion (Actual)
December 1, 2021
Study Completion (Actual)
September 14, 2022
Study Registration Dates
First Submitted
August 22, 2019
First Submitted That Met QC Criteria
August 22, 2019
First Posted (Actual)
August 28, 2019
Study Record Updates
Last Update Posted (Actual)
February 20, 2024
Last Update Submitted That Met QC Criteria
February 15, 2024
Last Verified
February 1, 2024
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- H00017891
- 1R18HS02592401 (Other Grant/Funding Number: Agency for Healthcare Research and Quality (AHRQ))
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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