GeriMedRisk®, a telemedicine geriatric pharmacology consultation service to address adverse drug events in long-term care

The primary outcome measures of this feasibility study will scrutinize the logistics of the GeriMedRisk® intervention and study design:
1. Number of clinicians who use GeriMedRisk® (GeriMedRisk® (GMR) database) (Timing: monthly after commencement of access to GeriMedRisk):
1.1. MD
1.2. Pharmacist
1.3. NP
1.4. Through TAPERMD
2. Number of clinicians who decline GeriMedRisk® (Roster of LTC clinicians, GMR database) (Timing: monthly after commencement of access to GeriMedRisk):
2.1. MD
2.2. Pharmacist
2.3. NP
3. Number of patients/Substitute Decision Makers who decline GeriMedRisk®. Patients and their caregivers will have the opportunity to opt out of GeriMedRisk®. These will be individually reported and collected real time. (Timing: monthly after commencement of access to GeriMedRisk)
4. Number of consults (GMR database, OTN) (Timing: monthly after commencement of access to GeriMedRisk):
4.1. Telephone
4.2. Telemedicine: OTN e-consult
4.3. Through TAPERMD
4.3.1. Telephone
4.3.2. Telemedicine: OTN e-consult
5. Wait times: (telephone records, OTN) (Timing: monthly after commencement of access to GeriMedRisk):
5.1. Telephone
5.1.1. Time from the conclusion of the initial automated message to:
5.1.1.1. When GeriMedRisk® team member picks up the phone (telephone records)
5.1.1.2. When Caller hangs up (telephone records)
5.1.1.2.1. To use e-consult (telephone records, OTN)
5.1.1.2.2. To leave a call back number (telephone records)
5.1.1.2.3. No further contact in the next 7 days (dropped call) (telephone records, OTN)
5.2. E-consult: Time from e-consult request received to (OTN):
5.2.1. GeriMedRisk® team member commences consult
5.2.2. GeriMedRisk® team member provides e-consult opinion
6. Length of calls (telephone records, GMR database) (Timing: monthly after commencement of access to GeriMedRisk):
6.1. Initial consult with pharmacist/RN
6.2. Initial consult with physician
6.3. Follow up with pharmacist/RN
6.4. Follow up with physician
6.4.1. Geriatrician/clinical pharmacologist
6.4.2. Geriatric psychiatrist
6.5. Stratify above for TAPERMD referrals.
7. Time to follow-up call (GMR database, OTN) (Timing: monthly after commencement of access to GeriMedRisk):
7.1. Defined as time interval from date of initial consult to date of follow up
7.1.1. Measure discrepancies between scheduled followup dates and date of actual followup.
7.2. Number lost to follow up
8. Satisfaction (GMR database, OTN) (Timing: monthly after commencement of access to GeriMedRisk):
8.1. Adherence to recommendations (satisfaction) defined as the percentage of GeriMedRisk® recommendations which were executed by the referring clinician. (GMR database, collected during follow up call). 60% adherence is defined as a positive outcome:
8.1.1. Stratify according to referring clinician clinical background (MD, Pharmacist or NP)
8.1.2. 2 days, 7 days and 14 days post consultation
8.2. Number of times referring clinician uses service (i.e., repeat use may indicate satisfaction)
9. Number of consults requiring physician support (GMR database and OTN) (Timing: monthly after commencement of access to GeriMedRisk):
9.1. Geriatric medicine
9.2. Clinical pharmacology
9.3. Geriatric psychiatry
10. Case complexity (composite of number of consults requiring physician support, number of consults with polypharmacy defined as ≥4 medications, # of consults requiring geriatric psychiatry and ≥ 3 follow up) (Timing: monthly after commencement of access to GeriMedRisk):
10.1. For entire participating LTC site
10.2. For each consult
11. Case resolution: defined as patient discharged from GeriMedRisk® (GMR database, OTN) (Timing: monthly after commencement of access to GeriMedRisk):
11.1. Time required: Time of consult to case resolution
11.2. Number of steps required
11.3. Type of steps required
12. Number of GeriMedRisk® MDs (GMR database, OTN) (Timing: monthly after commencement of access to GeriMedRisk):
12.1. Specialty training:
12.1.1. Geriatric medicine
12.1.2. Clinical pharmacology
12.1.3. Geriatric psychiatry
13. Compensation/Cost-effectiveness (OTN, GeriMedRisk® budget) (Timing: monthly after commencement of access to GeriMedRisk):
13.1. MD: Fee-for-service billing
13.2. MD: e-consult hourly billing
13.3. Pharmacist/Nurse: Salary

Secondary outcomes include falls, hospital visits and medications. Completeness of secondary outcome data (RAI-MDS LTC electronic medical record). This data is regularly collected with the Minimum Data Set, as mandated by the Ministry of Health and Long-Term Care (Timing: 1 year lookback period defined as -365 to date of intervention, and following the commencement of access to GeriMedRisk, monthly)
1. Falls:
1.1. Monthly rate for entire LTC home
1.2. % of injurious falls (defined as requiring physician services, Emergency Department visit or hospitalization)
2. Emergency Hospital visits (exclude hospitalization recommended for supervised deprescription, or elective procedures):
2.1. For patients with a GeriMedRisk® consultation: Time to ED visit (defined as hours from pt consult to ED visit) (GMR database)
3. Medications:
3.1. Prevalence of potentially inappropriate medications
3.1.1. Dose reduction:
3.1.1.1. GeriMedRisk® patients (defined through TAPERMD; captured by GeriMedRisk® clinical database, pharmacy records)
3.1.1.2. All patients in the LTC site (RAI MDS 2.0, pharmacy records)
3.2. Prevalence of psychotropics per LTC site (defined as an sedative hypnotic, antidepressant, antianxiolytic, antipsychotic, Lithium) or antiseizure medication (without a diagnosed seizure disorder) (RAI MDS 2.0, LTC pharmacy records)
3.3. Prevalence of patients receiving opioids (LTC pharmacy records)