More than half of patients leave hospital with unintended discrepancies in their medicines—wrong doses, missing drugs, or duplications—and heart failure patients are especially vulnerable to the harm this causes. The problem is not a lack of good ideas. Systematic reviews show that patient support and better communication between healthcare staff can reduce these medication errors. But no one has built a practical, tested model that hospitals and GP surgeries can actually use. Most existing interventions focus only on the hospital stay and ignore what happens once the patient is home. Patients themselves are rarely consulted in the design. This programme will change that. Over five years, researchers will work with heart failure patients, clinicians, and data analysts across three English regions to co-design a “Medicines at Transitions Toolkit” (MaTT). They will map how medicines are currently managed from hospital discharge into primary care, link patient records to track outcomes, and test the toolkit in a randomised trial involving 2,100 patients across 42 NHS trusts. If the toolkit works, it could prevent thousands of avoidable medication errors, keep heart failure patients on the drugs that slow disease progression, and reduce hospital readmissions. The approach could then be adapted for other long-term conditions.
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Background Avoidable harm associated with medicines is widespread - particularly at care transitions. Unintended discrepancies in patients medicines after hospital discharge affect more than half of patients. The elderly and those taking multiple medicines are at particular risk and those with heart failure need attention if proven benefits in delayed disease progression and reduced mortality are to be realised. Our completed systematic review of approaches to improve continuity of medicines management at transitions found that patient support and improved healthcare professional communication can reduce risk but effective models for implementation are lacking. There were few multicentre studies, and few measured or showed benefits in health or clinical outcomes. Most interventions focused on the hospital with little patient involvement in their design. Our programme will develop and test a co-designed, theory-based, and fully costed complex intervention for patients with heart failure incorporating learning from existing good practice. In parallel we will measure the effect of this intervention through a novel data linkage process across the patient pathway. AimTo design and test a complex intervention to make best use of medicines and reduce harm through effective medicines management for heart failure patients from hospital discharge and into primary care.Objectives • Map and evaluate current medicines management pathways across care transitions• Devise an underlying data linkage and data collection exercise to measure the effect of the proposed intervention• Synthesise these data to develop a model of best practice that can contribute to a multi-disciplinary intervention• Based on a co-design process, develop a complex intervention, referred to as a Medicines at Transitions Toolkit (MaTT)• Assess the intervention for usability and acceptability, establish an effective implementation process, and determine the feasibility of data collection for economic evaluation• Evaluate the effect and cost effectiveness of the intervention in a multi-centre cluster-randomised trial, in conjunction with a rigorous process evaluation Research PlanThe four work packages, involve three regions (Yorkshire & Humber, the North West, and the North East).WP1 (mth 1-15) is a systems analysis using mixed methods to map and evaluate the cardiology medicines management pathway in four health economies from discharge through to primary care. In parallel, a data linkage exercise will demonstrate tracking of medicines and collection of outcome measures. WP2a & 2b (mth 6-15): 2a is a patient-led, experience-based co-design (EBCD) process to address patient information and staff training needs at care transitions. In WP2b, after user-testing specific informational tools, intervention modelling informed by behavior change theory and using COM-B, will combine the EBCD and WP1 outputs with the findings of our updated systematic review. WP3 (month 16-24) is a mixed method feasibility study with 30 patients across three health economies to establish the optimum implementation process for the intervention, assess usability and acceptability, identify implementation barriers and facilitators, and test our proposed data collection methods. We have specified progression criteria which we will need to meet to proceed to the full trial. WP3 will also pilot data collection for the economic evaluation.WP4 (month 16-68) is a 1:1 randomised, controlled cluster trial (WP4a) incorporating a comprehensive economic evaluation, and a process evaluation (WP4b). We will recruit 50 patients with HF over 12 months from cardiology ward(s) in each of 42 acute NHS trusts across our three regions (n=2100 patients). Assuming an estimated ICC of 0.01 and allowing for 15% patient attrition we will achieve 80% power at 5% significance level. An internal pilot will ensure an acceptable recruitment rate. A mixed method process evaluation will examine
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