Rationale and design of the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study.
BACKGROUND
Medication errors and adverse drug events are common after hospital discharge due to changes in medication regimens, suboptimal discharge instructions, and prolonged time to follow-up. Pharmacist-based interventions may be effective in promoting the safe and effective use of medications, especially among high-risk patients such as those with low health literacy.


RESULTS
The Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study is a randomized controlled trial conducted at 2 academic centers-Vanderbilt University Hospital and Brigham and Women's Hospital. Patients admitted with acute coronary syndrome or acute decompensated heart failure were randomly assigned to usual care or intervention. The intervention consisted of pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and tailored telephone follow-up after discharge. The primary outcome is the occurrence of serious medication errors in the first 30 days after hospital discharge. Secondary outcomes are health care utilization, disease-specific quality of life, and cost-effectiveness. Enrollment was completed September 2009. A total of 862 patients were enrolled, and 430 patients were randomly assigned to receive the intervention. Analyses will determine whether the intervention was effective in reducing serious medication errors, particularly in patients with low health literacy.


CONCLUSIONS
The PILL-CVD study was designed to reduce serious medication errors after hospitalization through a pharmacist-based intervention. The intervention, if effective, will inform health care facilities on the use of pharmacist-assisted medication reconciliation, inpatient counseling, low-literacy adherence aids, and patient follow-up after discharge. Clinical Trial Registration- clinicaltrials.gov. Identifier: NCT00632021.
Schnipper
Jeffrey L
JL
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Roumie
Christianne L
CL
Cawthon
Courtney
C
Businger
Alexandra
A
Dalal
Anuj K
AK
Mugalla
Ileko
I
Eden
Svetlana
S
Jacobson
Terry A
TA
Rask
Kimberly J
KJ
Vaccarino
Viola
V
Gandhi
Tejal K
TK
Bates
David W
DW
Johnson
Daniel C
DC
Labonville
Stephanie
S
Gregory
David
D
Kripalani
Sunil
S
D000046:Academic Medical Centers; D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000191:economics; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003376:Counseling; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D004347:Drug Interactions; D004522:Educational Status; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D055118:Medication Adherence; D008508:Medication Errors / Q000191:economics / Q000517:prevention & control*; D010351:Patient Discharge; D010353:Patient Education as Topic; D010595:Pharmacists; D024382:Professional Role; D011788:Quality of Life; D012107:Research Design; D013997:Time Factors; D014481:United States
D002317:Cardiovascular Agents