Journal article
Effect of Clinical Pharmacist Intervention on Medication Discrepancies Following Hospital Discharge
International journal of clinical pharmacy, Vol.36(2), pp.430-437
04/2014
DOI: 10.1007/s11096-014-9917-x
PMCID: PMC4026363
PMID: 24515550
Abstract
Background: Medication discrepancies may occur at transitions in care and negatively impact patient outcomes.
Objective: To determine if involving clinical pharmacists in hospital care, medication reconciliation and discharge medication plan communication can reduce medication discrepancies with a prospective, randomized, blinded, controlled trial.
Setting: A large, tertiary care, academic medical center.
Method: The intervention consisted of clinical pharmacist medication reconciliation, patient education and improved communication of the discharge medication plan, as devised by the hospital physician and care team, to primary care physicians and community pharmacists. Medication discrepancies were identified by blinded research pharmacists who reviewed primary care physician and pharmacy records at discharge through 90 days post-discharge to create 30- and 90-day medication lists.
Main outcome measure: Rate of medication discrepancies compared across groups.
Results: A total of 592 subjects from internal medicine, family medicine, cardiology and orthopedic services were evaluated for this study. Clinically important medication discrepancies in the primary care physician record were different between groups 30 days after hospital discharge following a clinical pharmacist's intervention. The mean number of medication discrepancies per patient for the enhanced group being nearly half the number in the control group. However, this effect did not persist to 90 days post-discharge and did not extend to community pharmacy records.
Conclusion: The present study demonstrates the involvement of pharmacists in hospital care, medication reconciliation and discharge medication plan communication may affect the quality of the outpatient medical record.
Details
- Title: Subtitle
- Effect of Clinical Pharmacist Intervention on Medication Discrepancies Following Hospital Discharge
- Creators
- T. Michael Farley - Department of Pharmacy Practice and Science University of Iowa College of Pharmacy and Clinical Pharmacist Specialist Mercy Hospital Iowa City 115 South Grand Avenue Iowa City, Iowa, 52242 No conflicts of interestConstance Shelsky - Department of Pharmacy Practice and Science University of Iowa College of Pharmacy No conflicts of interestShanique Powell - Department of Pharmacy Practice and Science University of Iowa College of Pharmacy No conflicts of interestKaren B Farris - Social and Administrative Sciences (Pharmacy) Graduate Program University of Michigan College of Pharmacy No conflicts of interestBarry L Carter - Department of Pharmacy Practice and Science University of Iowa College of Pharmacy College of Pharmacy and Professor, Department of Family Medicine Roy J. and Lucille A. Carver College of Medicine No conflicts of interest
- Resource Type
- Journal article
- Publication Details
- International journal of clinical pharmacy, Vol.36(2), pp.430-437
- DOI
- 10.1007/s11096-014-9917-x
- PMID
- 24515550
- PMCID
- PMC4026363
- NLM abbreviation
- Int J Clin Pharm
- ISSN
- 2210-7703
- eISSN
- 2210-7711
- Language
- English
- Date published
- 04/2014
- Academic Unit
- Pharmacy Practice and Science
- Record Identifier
- 9984065320002771
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