About the research
When a patient moves between care settings (e.g. from hospital to home) medicine problems are common and planned changes are not always followed through. Patients particularly at risk are those with long-term illnesses taking several medicines – especially when medicines have been started or changed in hospital.
Patients with heart failure are the focus of our study as they are a public health and NHS priority, are frequent service users (including readmission to hospital), and susceptible to poorly managed medicines. Heart failure is responsible for approximately 5% of medical admissions and the hospital readmission rate within 3 months of discharge has been estimated as being as high as 50%.
ISCOMAT aims to help the way patients are supported with their medicines. This may contribute to improving their health through helping them better understand their medicines. It also aims to improve the way medical professionals work together to offer good standards of care to patients when they leave hospital.
The programme will design and test a complex intervention (a Medicines at Transitions Toolkit) – co-designed with patients and clinicians – to make best use of medicines and reduce harm through effective medicines management for heart failure patients from hospital discharge and into primary care.
- To map and evaluate current medicines management pathways for patients with heart failure being discharged from hospital
- Using an experience-based co-design process, to develop a complex intervention, referred to as a Medicines at Transitions Toolkit (MaTT)
- To devise an underlying data linkage and data collection exercise to measure the effect of the proposed intervention
- 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
ISCOMAT will be delivered in four different work packages, each of which is briefly described below:
Work package 1 - Systems Analysis
Work Package one is a systems analysis using mixed methods to map and evaluate the cardiology medicines pathway from discharge to primary care in four healthcare areas. This will comprise observations and documentary analysis in hospitals, interviews with staff in hospital and in primary care and interviews with patients at discharge and then at two later time points.
We will simultaneously design a data linkage exercise to join up data from different data sets, including nationally collected heart failure outcomes data, hospital data and primary care data.
Work packages 2a and 2b - Intervention
Work packages 2a and 2b aim to develop and test an intervention to optimise patients’ heart failure medicines. First of all, work package 2a comprises using the outputs of work package 1 to deliver a patient-led experience-based co-design (EBCD) to address patient information and staff training needs at care transitions.
Work package 2b will user test outputs of work package 2a and model an intervention informed by behaviour-change theory and the outputs of the systematic review previously undertaken by team members.
Work package 3 - Feasibility study
Work package 3 is a mixed-methods feasibility study with 30 patients across three healthcare areas to establish the optimum implementation process for the intervention, assess usability and acceptability, identify key facilitators and barriers to implementation and test data collection methods. We will also pilot data collection methods for economic evaluation.
Work package 4 - Trial
Work package 4 is a randomised cluster control trial, economic evaluation and process evaluation in 42 NHS trusts in three regions (n=2100 patients. The mixed-methods process evaluation will examine the effect of organisational context and setting and optimal ways of implementing the intervention.