BACKGROUND: Hospitalization and subsequent discharge home often involve discontinuity of care, multiple changes in medication regimens, and inadequate patient education, which can lead to adverse drug events (ADEs) and avoidable health care utilization. Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and follow-up by pharmacists on preventable ADEs. METHODS: We conducted a randomized trial of 178 patients being discharged home from the general medicine service at a large teaching hospital. Patients in the intervention group received pharmacist counseling at discharge and a follow-up telephone call 3 to 5 days later. Interventions focused on clarifying medication regimens; reviewing indications, directions, and potential side effects of medications; screening for barriers to adherence and early side effects; and providing patient counseling and/or physician feedback when appropriate. The primary outcome was rate of preventable ADEs. RESULTS: Pharmacists observed the following drug-related problems in the intervention group: unexplained discrepancies between patients' preadmission medication regimens and discharge medication orders in 49% of patients, unexplained discrepancies between discharge medication lists and postdischarge regimens in 29% of patients, and medication nonadherence in 23%. Comparing trial outcomes 30 days after discharge, preventable ADEs were detected in 11% of patients in the control group and 1% of patients in the intervention group (P = .01). No differences were found between groups in total ADEs or total health care utilization. CONCLUSIONS: Pharmacist medication review, patient counseling, and telephone follow-up were associated with a lower rate of preventable ADEs 30 days after hospital discharge. Medication discrepancies before and after discharge were common targets of intervention.
RCT Entities:
BACKGROUND: Hospitalization and subsequent discharge home often involve discontinuity of care, multiple changes in medication regimens, and inadequate patient education, which can lead to adverse drug events (ADEs) and avoidable health care utilization. Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and follow-up by pharmacists on preventable ADEs. METHODS: We conducted a randomized trial of 178 patients being discharged home from the general medicine service at a large teaching hospital. Patients in the intervention group received pharmacist counseling at discharge and a follow-up telephone call 3 to 5 days later. Interventions focused on clarifying medication regimens; reviewing indications, directions, and potential side effects of medications; screening for barriers to adherence and early side effects; and providing patient counseling and/or physician feedback when appropriate. The primary outcome was rate of preventable ADEs. RESULTS: Pharmacists observed the following drug-related problems in the intervention group: unexplained discrepancies between patients' preadmission medication regimens and discharge medication orders in 49% of patients, unexplained discrepancies between discharge medication lists and postdischarge regimens in 29% of patients, and medication nonadherence in 23%. Comparing trial outcomes 30 days after discharge, preventable ADEs were detected in 11% of patients in the control group and 1% of patients in the intervention group (P = .01). No differences were found between groups in total ADEs or total health care utilization. CONCLUSIONS: Pharmacist medication review, patient counseling, and telephone follow-up were associated with a lower rate of preventable ADEs 30 days after hospital discharge. Medication discrepancies before and after discharge were common targets of intervention.
Authors: Aileen B Dequito; Peter G M Mol; Jasperien E van Doormaal; Rianne J Zaal; Patricia M L A van den Bemt; Flora M Haaijer-Ruskamp; Jos G W Kosterink Journal: Drug Saf Date: 2011-11-01 Impact factor: 5.606
Authors: Charles T Taylor; Alex J Adams; Erin L Albert; Elizabeth A Cardello; Kalin Clifford; Jay D Currie; Michael Gonyeau; Steven P Nelson; Lynette R Bradley-Baker Journal: Am J Pharm Educ Date: 2015-10-25 Impact factor: 2.047
Authors: Amna Al-Hashar; Ibrahim Al-Zakwani; Tommy Eriksson; Alaa Sarakbi; Badriya Al-Zadjali; Saif Al Mubaihsi; Mohammed Al Za'abi Journal: Int J Clin Pharm Date: 2018-05-12
Authors: Andrew D Auerbach; Sunil Kripalani; Eduard E Vasilevskis; Neil Sehgal; Peter K Lindenauer; Joshua P Metlay; Grant Fletcher; Gregory W Ruhnke; Scott A Flanders; Christopher Kim; Mark V Williams; Larissa Thomas; Vernon Giang; Shoshana J Herzig; Kanan Patel; W John Boscardin; Edmondo J Robinson; Jeffrey L Schnipper Journal: JAMA Intern Med Date: 2016-04 Impact factor: 21.873
Authors: Jennifer Tjia; Alice Bonner; Becky A Briesacher; Sarah McGee; Eileen Terrill; Kathleen Miller Journal: J Gen Intern Med Date: 2009-03-17 Impact factor: 5.128
Authors: Jennifer R Pippins; Tejal K Gandhi; Claus Hamann; Chima D Ndumele; Stephanie A Labonville; Ellen K Diedrichsen; Marcy G Carty; Andrew S Karson; Ishir Bhan; Christopher M Coley; Catherine L Liang; Alexander Turchin; Patricia C McCarthy; Jeffrey L Schnipper Journal: J Gen Intern Med Date: 2008-06-19 Impact factor: 5.128