Key result
Pharmacist-led postdischarge medication reconciliation identifies ~3 medication-related problems per primary care visit.
Why the study?
Medication-related problems during hospital discharge transitions of care visits in primary care are not well quantified or evaluated, particularly regarding the pharmacist's role.
Cohort (n=134)
No
Pharmacist integration into primary care transitions of care teams effectively identifies and addresses numerous medication-related problems and adverse drug events post-hospital discharge.
Pharmacist-led post-discharge visits identified ~3 MRPs each, including frequent EHR inaccuracies; supports pharmacist integration in FQHC transitions of care but leaves impact on outcomes open.
Objectives: The objective of this study was to identify and evaluate medication-related problems (MRPs) found during hospital discharge transitions of care visits in a primary care setting. Design, Settings, and Participants: This retrospective cohort took place within a federally qualified health center (FQHC) where pharmacists are part of the interprofessional transitions of care team to help patients transition back to primary care after being discharged from the hospital. Pharmacists utilized standardized forms to document MRPs, potential and adverse drug events, and interventions made during the visit. This study quantifies the role that pharmacists can have by conducting medication reconciliation during postdischarge primary care visits. Patients included in this study were 18 years and older with at least 5 medications. Outcome Measures: The outcomes of this study include the number and type(s) of MRPs, number and severity of potential adverse drug events (pADEs) and adverse drug events (ADEs) that were identified, as well as the number and type of recommendations or interventions made by the pharmacist. The MRP types and pADE/ADE severity were classified and stratified using predetermined definitions. Results: During the 4-month study period from October 1, 2018 to February 4, 2019, 134 visits were completed. Outcomes included a total of 454 MRPs, with an average of 3 identified per visit. The most common MRPs were medication list in electronic health record inaccurate (79.1% of visits), poor adherence (32.1% of visits), and refills needed (30.6% of visits). A total of 72 pADEs and 27 ADEs were identified, with 524 recommendations made. Conclusion: Pharmacists serve a unique role during transitions of care by identifying MRPs. Pharmacists are an integral part of a patient’s health care team by making recommendations or interventions related to these MRPs. FQHCs and other primary care settings should consider integrating pharmacists into a collaborative transitions of care team.
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Dellogono et al. (2020) conducted a cohort in Hospital discharge (n=134). Pharmacist-conducted medication reconciliation was evaluated on Number and type of medication-related problems (MRPs), potential adverse drug events (pADEs), adverse drug events (ADEs), and pharmacist recommendations. Pharmacist-conducted medication reconciliation during 134 postdischarge primary care visits identified 454 medication-related problems (average 3 per visit), 72 potential ADEs, and 27 ADEs.
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