Drug-related problems at discharge: results on the Spanish pharmacy discharge programme CONSULTENOS.
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.
López
Maángeles Pardo
MP
Pharmacy Department, Hospital Universitario de San Juan, Alicante, Spain.
Saliente
Ma Teresa Aznar
MT
Company
Enrique Soler
ES
Monsalve
Ana Garcia
AG
Cueva
Marta Aparício
MA
Domingo
Elena Arroyo
EA
Hernández
Monica Montero
MM
Carrión
Carmen Carrión
CC
Martí
Monica Climente
MC
Querejeta
Nuria Bujaldón
NB
Blasco
Joaquín Borrás
JB
Milá
Amparo Rocher
AR
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