title: The outcome of pharmacist counseling at the time of hospital discharge: an observational nonrandomized study.
abstract: OBJECTIVE
  Adverse drug events (ADEs) may occur after discharge from acute care hospitalization because of limited instruction on medications at discharge. The right instructions given to patients may reduce the risk of ADEs. The objective of our study was to assess a program involving comprehensive medication counseling provided by pharmacists at the time of discharge from a tertiary hospital in Riyadh, Saudi Arabia.
  
  
  METHODS
  A prospective, nonrandomized observational study over a period of 3 months in a 1000-bed tertiary hospital.
  
  
  METHODS
  Patients discharged from the internal medicine wards with more than three medications received comprehensive pharmacist counseling. The intervention pharmacist counseled patients about their discharge medications and provided written materials as needed. Topics discussed with the patients included the importance of following prescribed medication regimens and the indications, directions, and any potential side effects of discharge medications. The control group included similar patients who received routine discharge counseling by nurses. Two weeks after discharge, the same pharmacist called the patients and assessed the frequency of ADEs. Two independent clinicians reviewed each ADEs and judged its severity and preventability.
  
  
  RESULTS
  Out of 200 patients included in the study (100 patients from the intervention group and 100 patients from the control group), 175 patients (87.5%) were successfully contacted two weeks after discharge (88 patients from the intervention group and 87 patients from the control group). ADEs occurred in 2 patients (2.3%) in the intervention group and in 21 patients (24%; 23 incidents in 21 patients) in the control group (P < .001). In the control group, 14 ADEs (61%) were judged as preventable, and 9 (39%) were judged as serious.
  
  
  CONCLUSIONS
  A comprehensive medication counseling program at hospital discharge reduced the incidence of ADEs two weeks after discharge from a tertiary hospital in Riyadh, Saudi Arabia. Further studies assessing the long-term outcomes of such a program are needed.
authors.affiliation: King Abdulaziz Medical City, National Guard Health Affairs, Saudi Arabia.
authors.forename: Sami Ali
authors.initials: SA
authors.lastname: Al-Ghamdi
authors.forename: Mansour Adam
authors.initials: MA
authors.lastname: Mahmoud
authors.forename: Maha Abdalaziz
authors.initials: MA
authors.lastname: Alammari
authors.forename: Abdulkareem Mohamed
authors.initials: AM
authors.lastname: Al Bekairy
authors.forename: Muneera
authors.initials: M
authors.lastname: Alwhaibi
authors.forename: Ahmad Yacoub
authors.initials: AY
authors.lastname: Mayet
authors.forename: Hisham Saad
authors.initials: HS
authors.lastname: Aljadhey
mesh_terms: D037001:Directive Counseling; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010595:Pharmacists; D011446:Prospective Studies