PROJECT SUMMARY/ABSTRACT
Socioeconomically disadvantaged populations with multiple chronic conditions have high rates of
nonadherence to essential chronic disease medications after hospital discharge. Medication nonadherence
after hospital discharge is significantly associated with increased mortality and higher rates of readmissions
and costs among these patients. Major patient-reported barriers to essential medication use after hospital
discharge among low-income individuals are related to social determinants of health (SDOH) and include: 1)
financial barriers (i.e. inability to afford medications), 2) transportation barriers (i.e. inability to access
prescribed medications or needed follow-up care), and 3) system-level barriers (i.e. lack of availability of
discharge medications and care coordination services to ensure rapid primary care follow-up). Although,
medication therapy management and medication reconciliation services are important during care transitions,
these services have not proven effective in improving medication adherence after hospital discharge,
highlighting a critical need for innovative interventions. Our pilot study has demonstrated the feasibility and
potential to improve medication adherence among adult Medicaid and uninsured inpatients through full
medication subsidy and/or bedside and subsequent home delivery of medications during and after care
transitions. Moreover, our previous research found that support from certified pharmacy technicians trained as
coaches effectively increases rapid primary care follow-up after hospital discharge and could improve
medication adherence. Yet the effectiveness of interventions that directly address affordability, accessibility,
and availability to improve post-discharge medication adherence in vulnerable populations is still unknown.
The Medication Affordability, Accessibility, and Availability in Care Transitions (Med AAAction) Study
will test the effectiveness of a pharmacy-led care transitions intervention versus usual care through a
pragmatic randomized controlled trial of 388 Medicaid and uninsured hospital in-patients with MCC from three
large healthcare systems in Tennessee. The intervention will involve: 1) medications with zero copay, 2)
bedside delivery then home delivery of medications, and 3) care coordination provided by certified pharmacy
technicians/health coaches to assist with medication access and rapid primary care follow-up. We will examine
the impact of the intervention during 12 months on 1) medication adherence (primary outcome) and 2) rapid
primary care follow-up, 30-day readmissions, hospitalizations and emergency department visits, and costs. We
will conduct key informant interviews to understand patient experience with the acre received during and after
care transitions. By examining effectiveness of the intervention on outcomes including medication adherence,
health care utilization, costs, and patient experience, this study will provide valuable results to health systems,
payers, and policymakers to assist in future implementation and sustainability of the intervention for
socioeconomically disadvantaged populations.
