The Medication Affordability, Accessibility, and Availability in Care Transitions (Med AAAction) Study: Design and methods for a pharmacy-led trial implemented in low-income populations.

BACKGROUND

Medication nonadherence disproportionately affects low-income populations, especially during care transitions, by increasing readmissions, emergency visits, and mortality. These populations face financial, transportation, and coordination barriers that traditional medication therapy management often fails to address, highlighting the need for innovative solutions. We are conducting a pragmatic randomized controlled trial to determine the effectiveness of the patient-centered Medication Affordability, Accessibility, and Availability in Care Transitions (Med AAAction) intervention to improve medication adherence and healthcare utilization among low-income patients with multiple chronic conditions (MCC).

METHODS

Low-income adults (≤ 200% federal poverty level) with MCC or using two or more chronic disease medications (N = 388) from two Tennessee hospitals are randomized to usual care or the Med AAAction intervention. Recruitment began in April 2024. This multicomponent intervention provides free (zero-copay) chronic disease medications with bedside and home delivery, health coaching, and care coordination by certified pharmacy technicians to assist with rapid and ongoing primary care follow-up after hospital discharge. The primary outcome is medication adherence measured using pill counts at 3, 6, 9, and 12-month by comparing doses taken with prescription supply and fill dates. Secondary outcomes include 14-day primary care follow-up, 30-day readmissions, and one-year hospitalizations, emergency visits, and healthcare costs.

DISCUSSION: By addressing medication affordability, accessibility, and availability, this trial tests whether a patient-centered multicomponent intervention improves medication adherence and reduces healthcare use among low-income adults with MCC. If effective, Med AAAction could be implemented across health systems to support high-risk patients and enhance health outcomes while lowering costs.