title: Drug-related problems at discharge: results on the Spanish pharmacy discharge programme CONSULTENOS.
abstract: OBJECTIVE
  The aim of this study was to describe the most common drug-related problems (DRPs) found after discharge, pharmacist interventions and their results for the patients enrolled on the CONSULTENOS programme.
  
  
  METHODS
  An observational, prospective, multicentre study was conducted to evaluate the results of a pharmaceutical care programme at discharge. Patients from 10 hospitals participating in the CONSULTENOS programme were enrolled. Pharmacists conducting this programme were newly graduated and worked under the supervision of a pharmacy staff member; only two pharmacists had previous hospital pharmacy experience. DRPs were identified and classified according to the Iaser methodology. Frequencies, types of DRP, interventions and outcomes were registered prospectively, at discharge and during a follow-up call 7 days after leaving the hospital.
  
  
  RESULTS
  A total of 7711 patients were included in the study. DRPs were detected in 23.7% of the patients, with a total of 2120 DRPs (1788 at discharge and 332 in the follow-up). The most common problems identified at discharge were twofold: firstly the need of an additional treatment (34.1%) and secondly an unnecessary treatment (18.1%). In the follow-up phone call the most frequent DRPs were adverse effects (29.2%). Besides the standard educational interventions at discharge, 3313 extra interventions were performed, of which 85% were accepted. The outcomes for the patients were positive in 80% of the cases, although documentation with objective or subjective data was rare.
  
  
  CONCLUSIONS
  DRPs occur frequently after patient discharge. A pharmaceutical care programme can identify and solve DRPs in this scenario. The clinical impact of the pharmacists' interventions should be better addressed.
authors.affiliation: Pharmacy Department, Hospital Universitario de San Juan, Alicante, Spain.
authors.forename: Maángeles Pardo
authors.initials: MP
authors.lastname: López
authors.forename: Ma Teresa Aznar
authors.initials: MT
authors.lastname: Saliente
authors.forename: Enrique Soler
authors.initials: ES
authors.lastname: Company
authors.forename: Ana Garcia
authors.initials: AG
authors.lastname: Monsalve
authors.forename: Marta Aparício
authors.initials: MA
authors.lastname: Cueva
authors.forename: Elena Arroyo
authors.initials: EA
authors.lastname: Domingo
authors.forename: Monica Montero
authors.initials: MM
authors.lastname: Hernández
authors.forename: Carmen Carrión
authors.initials: CC
authors.lastname: Carrión
authors.forename: Monica Climente
authors.initials: MC
authors.lastname: Martí
authors.forename: Nuria Bujaldón
authors.initials: NB
authors.lastname: Querejeta
authors.forename: Joaquín Borrás
authors.initials: JB
authors.lastname: Blasco
authors.forename: Amparo Rocher
authors.initials: AR
authors.lastname: Milá
mesh_terms: D000328:Adult; D000368:Aged; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010607:Pharmacy Service, Hospital