title: Impact of drug reconciliation at discharge and communication between hospital and community pharmacists on drug-related problems: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Patients are at risk of drug-related problems (DRPs) at transition points during hospitalization. The community pharmacist (CP) is often the first healthcare professional patients visit after discharge. CPs lack sufficient information about the patient and so they may be unable to identify problems in medications, which may lead to dispensing the wrong drugs or dosage, and/or giving wrong information. We aim to assess the impact of a complex intervention comprising of medication reconciliation performed at discharge by a hospital pharmacist (HP) with communication between the HP and CP on DRPs during the seven days following discharge.
  
  
  METHODS
  The study is a cluster randomized crossover trial involving 46 care units (each unit corresponding to a cluster) in 22 French hospitals during two consecutive 14-day periods, randomly assigned as 'experimental' or 'control' (usual care) periods. We will recruit patients older than 18 years of age and visiting the same CP for at least three months. We will exclude patients with a hospital length of stay of more than 21 days, who do not return home or those in palliative care. During the experimental period, the HP will perform a medications reconciliation that will be communicated to the patient. The HP will inform the patient's CP about the patient's drug therapy (modification in home medication, acute drugs prescribed, nonprescription treatments, and/or lab results). The primary outcome will be a composite outcome of any kind of drug misuse during the seven days following discharge assessed at day seven (±2) post-discharge by a pharmacist in charge of the study who will contact both patients and CPs by phone. The secondary outcome will be unplanned hospitalizations assessed by phone contact at day 35 (±5) after discharge. We plan to recruit 1,176 patients.
  
  
  CONCLUSIONS
  This study will assess the impact of a reconciliation of medications performed at patient discharge followed by communication between the HP and the patient's CP. It will allow for identifying the type of patients in France for which the intervention is most relevant.
  
  
  BACKGROUND
  This study was registered with ClinicalTrials.gov (number: NCT02006797) on 5 December 2013.
authors: Pharmacy Department, Pharm D, Tours University Hospital, 2 boulevard Tonnelle, 37044 Tours cedex 09, France. x.pourrat@chu-tours.fr.
authors: Xavier
authors: X
authors: Pourrat
authors: Clarisse
authors: C
authors: Roux
authors: Brigitte
authors: B
authors: Bouzige
authors: Valérie
authors: V
authors: Garnier
authors: Armelle
authors: A
authors: Develay
authors: Benoit
authors: B
authors: Allenet
authors: Martial
authors: M
authors: Fraysse
authors: Jean-Michel
authors: JM
authors: Halimi
authors: Jacqueline
authors: J
authors: Grassin
authors: Bruno
authors: B
authors: Giraudeau
mesh_terms: D002985:Clinical Protocols; D003142:Communication; D003157:Community Pharmacy Services; D003299:Cooperative Behavior; D018592:Cross-Over Studies; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology / Q000517:prevention & control; D005602:France; D006801:Humans; D007373:Interinstitutional Relations; D059065:Medication Reconciliation; D010348:Patient Care Team; D010351:Patient Discharge; D018579:Patient Selection; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D012107:Research Design; D012307:Risk Factors; D018401:Sample Size