Effect of Medication Management at Home Via Pharmacy Home Televisits

Older Veterans, particularly those with multiple chronic conditions requiring complex medication regimens, are more susceptible to adverse effects of medications. In this study, the investigators will examine the effect of a pharmacist led medication management intervention delivered by home televisit on improving medication use. The investigators anticipate that televisit to home by pharmacist for medication management may enhance use of medications at home by Veterans particularly those with complex medication regimens.

Study Overview

• Status: Completed
• Conditions: Deprescribing; Telemedicine; Polypharmacy
• Intervention / Treatment: Behavioral: Medication management via televisit to home

Detailed Description

Older adults are more likely to suffer from multiple chronic conditions, to be prescribed multiple medications, and are more susceptible to adverse effects of medications. In addition, older adults often use over-the-counter medications and supplements, further complicating their medication regimen. Complex medication regimens are potentially harmful to older adults due to potential drug interactions, potentially inappropriate prescribing or over-the-counter drug use, and medication non-adherence that may lead to poor control of chronic disease. Interventions aimed at reducing medication discrepancy in the ambulatory clinic setting, such as the review of written medication lists, and implementation of "brown bag" reconciliation (asking patients to bring in all medication bottles for review in the clinic) continues to be challenging and have limited success. Clinical pharmacist led interventions to improve appropriate medication use in older adults, including the application of the START/STOPP criteria, have demonstrated effectiveness in reducing adverse drug events. With the increased capability of VA telemedicine to reach Veteran in their homes, delivering medication management via televisit by clinical pharmacists has the potential to yield similar benefits for a larger number of older Veterans.

Telemedicine is an increasingly vital component within VHA to increase access and improve quality of care. By extending care beyond brick-and-mortar clinics, telemedicine increases the reach of care teams and is more convenient for patients, resulting in improved patient satisfaction. Using the capability of telemedicine to reach patients' homes, the investigators propose to examine the effect of medication management by clinical pharmacists via home video televisits, as home video visits have the potential to provide direct visualization of medications in older adults' homes, thereby reducing medication discrepancy and increasing medication adherence. Pharmacist management for older adult medication regimen may also improve appropriate medication use in older adults through direct pharmacist-patient interview and education. In support of this application, preliminary data from the team of investigators demonstrate acceptability of video televisits by older adults, that there is good uptake by patients and VA providers, and that video televisits into the home are feasible.

In this study, the investigators aim to develop a protocol for pharmacy home televisits for medication management in older adults who have multiple chronic conditions and are on multiple medications. The investigators will then conduct a randomized trial to examine the effect of these televisits on appropriate medication use, medication discrepancies, adherence and adverse drug events. The investigators anticipate that a pharmacist led medication management home televisit intervention will lead to reduction in potentially inappropriate use of medication, reduction in medication discrepancies, increased medication adherence and reduced adverse drug events in older adults compared to older adults receiving usual care. The investigators will also examine the potential challenges in implementing the intervention so that the study findings may inform future implementation.

• Study Type: Interventional
• Enrollment (Actual): 304
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Bedford, Massachusetts, United States, 01730-1114
      • VA Bedford HealthCare System, Bedford, MA
  • New York
    • The Bronx, New York, United States, 10468-3904
      • James J. Peters VA Medical Center, Bronx, NY

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Had at least 1 VA primary care visit within past year
• At least 2 chronic conditions
• At least 5 daily medications

Exclusion Criteria:

• Dementia diagnosis
• Lacks capacity for informed consent

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; Receives pharmacist home televisit for medication management	Behavioral: Medication management via televisit to home; Pharmacist led home based televisit for medication management
No Intervention: Usual Care; Usual care for outpatient medication management

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of subjects with Potentially inappropriate medication use	Potentially inappropriate medication use (PIM) assessed by blinded reviewer.	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Medication Appropriateness	Measured using Medication Appropriateness Index	6 months
Adverse drug events	Assessed from subject survey and chart review and rated as preventable vs. nonpreventable	6 months
Medication self efficacy	Measured using patient reported "Medication Understanding Use and Self-Efficacy Scale"	6 months

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: William W Hung, MD AB MPH, James J. Peters Veterans Affairs Medical Center; Principal Investigator: Lauren Rachel Moo, MD, VA Bedford HealthCare System, Bedford, MA

Publications and helpful links

General Publications

• Hawley CE, Wagner C, Venegas MD, Genovese N, Triantafylidis LK, McCullough MB, Beizer JL, Hung WW, Moo LR. Connecting the disconnected: Leveraging an in-home team member for video visits for older adults. J Am Geriatr Soc. 2024 May;72(5):1408-1419. doi: 10.1111/jgs.18663. Epub 2023 Nov 13.
• Hossain SR, Samant AN, Balsamo BC, Hawley CE, Zanchelli MC, Zhu C, Venegas MD, Robertson M, McCullough MB, Beizer JL, Boockvar KS, Siu AL, Moo LR, Hung WW. Effect of Medication Management at Home via Pharmacist-Led Home Televisits: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc. 2025 Feb 5;14:e65141. doi: 10.2196/65141.

Study record dates

Study Major Dates

• Study Start (Actual): July 16, 2020
• Primary Completion (Actual): December 31, 2025
• Study Completion (Actual): December 31, 2025

Study Registration Dates

• First Submitted: April 7, 2020
• First Submitted That Met QC Criteria: April 7, 2020
• First Posted (Actual): April 9, 2020

Study Record Updates

• Last Update Posted (Estimated): January 8, 2026
• Last Update Submitted That Met QC Criteria: January 6, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: deprescribing; polypharmacy; multiple chronic diseases
• Additional Relevant MeSH Terms: Pathologic Processes; Chronic Disease; Disease Attributes; Pathological Conditions, Signs and Symptoms; Multiple Chronic Conditions
• Other Study ID Numbers: IIR 18-286

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
• product manufactured in and exported from the U.S.: No