title: Impact of pharmacist discharge medication therapy counseling and disease state education: Pharmacist Assisting at Routine Medical Discharge (project PhARMD).
abstract: Many patients experience adverse events after discharge; numerous are medication related and preventable. The objective of this study is to evaluate the impact of pharmacist medication counseling and disease education at discharge. Pharmacist Assisting at Routine Medical Discharge is a prospective study of English- or Spanish-speaking adults discharged from internal medicine. Control patients received usual hospital discharge care; intervention patients received usual care with discharge counseling and a follow-up phone call. Evaluated outcomes included the following: 30-day hospital reutilization (combined readmissions/emergency department visits), pharmacist interventions, predictors for hospital utilization, patient satisfaction, and primary medication adherence. In all, 279 patients were enrolled: 139 in the control and 140 in the intervention group. Pharmacists made 198 interventions. The rate of hospital reutilization was 20.7% and similar between the intervention and control groups. Patients receiving the pharmacist intervention demonstrated improved primary medication adherence and increased patient satisfaction. Pharmacist-provided discharge counseling resulted in medication interventions, improved patient satisfaction, and increased medication adherence.
authors.affiliation: University of New Mexico Hospital, Pharmacy Administration, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA. psarangarm@salud.unm.edu
authors.forename: Preeyaporn
authors.initials: P
authors.lastname: Sarangarm
authors.forename: Matthew S
authors.initials: MS
authors.lastname: London
authors.forename: Stanley S
authors.initials: SS
authors.lastname: Snowden
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Dilworth
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Koselke
authors.forename: Christian O
authors.initials: CO
authors.lastname: Sanchez
authors.forename: Richard
authors.initials: R
authors.lastname: D'Angio
authors.forename: Gretchen
authors.initials: G
authors.lastname: Ray
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D059065:Medication Reconciliation; D008875:Middle Aged; D010351:Patient Discharge; D010353:Patient Education as Topic; D010359:Patient Readmission; D010595:Pharmacists; D024382:Professional Role; D015397:Program Evaluation