Implementation Strategies for a Pharmacist-Led Community-Based Care Transition Program for Rural Older Adults with Dementia and their Care Partners

University Of Michigan At Ann Arbor, Ann Arbor MI

Investigators

Abstract

PROJECT ABSTRACT Older adults living with Alzheimer’s disease and related dementias (ADRD) experience remarkably complex care transitions after hospitalization. Over half have medication problems (e.g., errors, discrepancies, inappropriate use), increased care partner burden, health-related (e.g., behavioral symptoms), and social needs after the care transition home. Our team has a sustained evidence-based care transition program for rural older adults, the Region VII Area Agency on Aging Community Care Transition Initiative (CCTI), including a community health worker (CHW) home visit and telehealth pharmacist medication review that addresses medication discrepancies and optimization, social and health-related needs, provides referrals and follow-up. Gaps in our knowledge of individual and organizational determinants to inform effective adaptations for rural older adults with ADRD and their care partners and successful implementation interventions appropriate for rural Area Agencies on Aging exist. The overall objective is to identify the key factors for adapting the CCTI for rural older adults with ADRD and their care partners (i.e., CCTI-ADRD) and to test the feasibility and acceptability of implementing the adapted CCTI-ADRD. The Tailored Implementation in Chronic Disease (TICD) framework informs our aims. AIM 1: Determine factors for adapting and implementing the Community Care Transition Initiative-ADRD to address medication problems, care partner burden, and health and social needs of rural older adults with ADRD and their care partners. We will conduct semi-structured interviews and direct observations with key informants (those with ADRD and their care partners, CHWs, Area Agency on Aging staff, and healthcare providers) and use rapid qualitative analysis and the TICD framework to prioritize factors, critical adaptations, and implementation barriers and facilitators. With our community advisory board, comprised of older adults with ADRD and their care partners, pharmacists, CHWs, and Area Agency on Aging members, we will reach a consensus on our implementation toolkit and pilot study protocol. AIM 2: Test the feasibility and acceptability of implementing the Community Care Transition Initiative-ADRD in three rural Area Agencies on Aging. Using a mixed-methods implementation pilot study, we will assess our primary outcomes of feasibility and acceptability of the implementation strategies. Secondary outcomes are implementation fidelity, medication problems addressed, care partner burden, ADRD behavioral symptoms, and community- based services provided. Direct observations, surveys, chart reviews, and semi-structured interviews with key informants will be used. We will integrate our data, create a causal pathway diagram to examine why our implementation strategies worked, and refine our toolkit. The expected outcome is our tailored implementation toolkit to be tested further in a randomized hybrid effectiveness-implementation clinical trial. We will positively impact rural older adults with ADRD and their care partners by reducing medication problems and unmet social and health needs after the care transition home.