IMPACT OF CLINICAL PHARMACIST-LED MEDICATION RECONCILIATION AT HOSPITAL DISCHARGE ON REDUCING 30-DAY READMISSION RATES AND ADVERSE DRUG EVENTS IN PAKISTAN

Abstract

One of the most significant changes in the care process is hospital discharge, which is linked to an increased risk of medication mistakes, adverse drug events (ADEs), and unscheduled readmission. Inadequate medication reconciliation, poor comprehension of discharge instructions, and insufficient follow-up are all significantly impacted by these avoidable problems. Clinical pharmacists have the chance to improve patient care and medication administration while educating patients throughout the transition gap. This study sought to determine how a pharmacist-led transitional care intervention affected patients' medication awareness and adherence, adverse drug events, medication discrepancies, and 30-day readmission.At a tertiary care facility, this was a randomized controlled experiment. 392 of the 600 patients who underwent eligibility screening were chosen at random to receive either the intervention (n = 196) or the control (n = 196). Medication reconciliation upon discharge, individual patient counseling regarding discharge medication, and phone follow-up on Days 7 and 30 following discharge were the three components of the intervention. As usual, the control group was released.30-day all-cause hospital readmissions and adverse medication events during the 30-day post-discharge period were the main outcome endpoints. Medication discrepancies discovered at discharge, patient understanding of prescribed drugs at Day 7 (assessed using a structured questionnaire), and medication adherence at Day 30 (assessed using the 8-item Morisky Medication Adherence Scale: MMAS-8) were secondary outcomes. Adverse drug events were assessed using the Naranjo Adverse Drug Event Probability Score. Analysis was done on 385 participants who finished the follow-up.Patients in the pharmacist-led intervention group outperformed those in the usual care group in terms of clinical outcomes. The intervention group had a significantly reduced 30-day hospitalization rate than the control group (12.1% vs. 20.5%, p = 0.024). Similarly, there was a substantial decrease in the occurrence of adverse medication events (10.0% vs. 17.4%, p = 0.029).Additionally, the number of drug discrepancies at discharge was significantly reduced by the intervention, with a mean of 0.7 ± 0.8 discrepancies per patient as opposed to 2.3 ± 1.2 in the control group (p < 0.001). At Day 7, the pharmacist counseling group's Medication Knowledge scores were significantly higher (8.5 ± 1.3 vs. 6.0 ± 2.0, p < 0.001). Additionally, by Day 30, 77.4% of the intervention group had high medication adherence, compared to 59.0% of the usual care group (p < 0.001). Both groups' clinical and demographic characteristics were comparable.30-day hospital re-admission rates, adverse medication events, and medication discrepancies were all found to be significantly lower as part of a pharmacist-led transitional care program. Additionally, patient knowledge and medication adherence following hospital discharge were found to have increased. The study's findings highlight the critical role clinical pharmacists play in the multidisciplinary discharge team and the necessity of integrating pharmacist-led medication reconciliation services into hospitalized patients' routine care in order to improve patient safety and health outcomes.