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Innovation Update

Technology-Enabled, Pharmacist-Led Innovation Leads to Improved Outcomes in Veteran Organ Transplant Recipients: Results of an HSR&D Funded, Multicenter, Cluster-Randomized Clinical Trial

Drug-related problems (DRPs), which include medication errors, nonadherence, and adverse events, significantly contribute to undesirable outcomes in transplant recipients. Studies demonstrate that DRPs occur in two-thirds of transplant recipients, leading to avoidable hospitalizations in 1 out of every 8 recipients. In addition, in the long term, transplant patients are commonly referred to local nontransplant providers for management, and patient care is often provided across multiple health systems. This can lead to fragmented care further propagating the risk for medication errors. Our research group has demonstrated that this is a major issue faced by Veteran transplant recipients.

To address this issue, we showed that a bioinformatics-driven dashboard coupled with a pharmacist-led intervention significantly improved immunosuppression monitoring within one VA healthcare system. Through a multicenter collaboration funded by the VA Health Services Research and Development Service, we substantially expanded the functionality of this bioinformatics dashboard and tested it in a 24-month, multicenter, cluster-randomized, parallel-arm, controlled clinical trial. Pharmacists at five intervention sites used the dashboard to address medication safety issues, compared with usual care provided at five control sites.

A total of 2,196 transplant patients were included (1,300 intervention vs. 896 control). During the two-year study, the intervention arm had a 11 percent absolute risk reduction of having ≥1 emergency department (ED) visit (44 percent vs. 56 percent, respectively) and a 12 percent absolute risk reduction of having ≥1 hospitalization (30 percent vs. 42 percent, respectively). In those with ≥1 event, the median ED visit rate (2 [interquartile range (IQR) 1, 5] vs 2 [IQR 1, 4]) and hospitalization rate (2 [IQR 1, 3] vs 2 [IQR 1, 3]) were similar. Treatment effect varied by comorbidity burden, previous ED visits or hospitalizations, and heart or lung recipients. This study demonstrated that an innovative, bioinformatics dashboard-enabled, pharmacist-led intervention reduced the risk of having at least one ED visit or hospitalization.