Most patients going home after a hospitalization have one or more medications they are taking. Problems with these medications occur in 11-17% of these patients, and there are additional issues related to non-adherence or non-maximal prescribing. In several clinical settings pharmacist interventions have been shown to reduce errors. A study reported in the Annals of Internal Medicine attempted to use clinical pharmacists to reduce errors upon patient discharge. (Annals Article) The value of such an intervention, especially for vulnerable populations like the elderly or people with cognitive impairment or low health literacy, lies in improving quality outcomes and reducing costs such as ER visits or hospital readmissions. The intervention included in-hospital counseling, adherence aids, education and individualized telephone follow-up after discharge.
The research was a randomized trial of about 850 heart failure and heart attack patients. The primary outcome was the number of clinically important medication errors per patient within 30 days. There was at least one medication error for half the patients, which shows just how widespread and significant this problem is. While there were slightly fewer errors in the intervention group, the effect did not reach statistical significance. Among the errors, most were significant, but almost a quarter were serious or life-threatening. In addition to actual errors, there were potential errors related to medication discrepancies or non-adherence among 30% of the patients. Looking at subgroups, the intervention appeared to have the highest effect among people with low health literacy and those with 10 or more medications. The results show that there is ample room for improving medication management and much potential benefit from doing so.