Study Title: Pharmacy-led Transitions of Care Intervention to Address System-Level Challenges and Improve Medication Adherence in Low-Income Populations

ABSTRACT Low-income 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 challenges to essential medication use after hospital discharge among low-income individuals are related to social determinants of health (SDOH) and include: 1) financial challenges (i.e. inability to afford medications), 2) transportation challenges (i.e. inability to access prescribed medications or needed follow-up care), and 3) system-level challenges (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 low-income 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 and ongoing 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 low-income populations.