2018 | Health Interoperability, Innovation and Learning

Randomized controlled study

Setting: Hospital

- To evaluate the effect of pharmacist's directed services (reconciliation plus counselling) on reducing medication discrepancies during a 3month study period - 200 internal medicine patients from Jordan University Hospital - 2 groups: control vs intervention

- The number and types of medication discrepancies

were identified at admission.

- At discharge, the number of unintentional discrepancies was evaluated for both groups

- The total number of identified unintentional discrepancies was 84 for the intervention group compared with 60 discrepancies for the control group.

- At discharge, a significant reduction in the number of unintentional discrepancies was achieved for the intervention group, while no significant change was found for the control group

- The presence of clinical pharmacists in hospital wards had a promising effect on decreasing the number of medication errors

Salameh

LK et al.

(2018)

No open access version available

Salameh LK, Farha RKA, Hammour KMA, Basheti IA. Impact of pharmacists directed medication reconciliation on reducing medication discrepancies during transition of
care in hospital setting. Journal of Pharmaceutical Health Services Research. 2018;10(1):149-156. doi:10.1111/jphs.12261

A cluster randomized trial

Setting: Community

- To compare the effectiveness of a consumer targeted, pharmacist-led educational intervention (to send patients an educational deprescribing brochure in parallel to sending their physicians an evidence-based pharmaceutical opinion) vs usual care on discontinuation of inappropriate medication among community-dwelling older adults.

- 69 community pharmacies were recruited

- Patients included were adults aged >/= 65yo who were prescribed 1 of 4 Beers criteria medications

- Pharmacist led intervention led to greater discontinuation of inappropriate prescriptions after 6 months.

- 106 of 248 patients (43%) in the intervention group no longer filled prescriptions for inappropriate medication compared with 29 of 241 (12%) in the control group.

A pharmacist-led educational intervention compared with usual care resulted in greater discontinuation of prescriptions

for inappropriate medication after 6 months

Martin P et al. (2018)

Martin P, Tamblyn R, Benedetti A, Ahmed S, Tannenbaum C. Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older
Adults. Jama. 2018;320(18):1889. doi:10.1001/jama.2018.16131