ArticleEuropean journal of hospital pharmacy : science and practice2018
Pharmacist-led interventions improve quality of medicine-related healthcare service at hospital discharge.
Article in European journal of hospital pharmacy : science and practice, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A systematic review of outcomes reported in studies to optimise the medication use of patients at hospital discharge.BMC health services research · 2025Pooled it
- Safe Handover or Lost in Transition?-A Retrospective Evaluation of Pharmacist Referrals to Primary Care Following Hospital Discharge.Pharmacy (Basel, Switzerland) · 2026Article
- An Underused Competence: Clinical Pharmacists' Experiences of Writing Referrals in Transitions of Care.Pharmacy (Basel, Switzerland) · 2026Article
- Evaluation of pharmacist's interventions in a Hospital Pharmacy of a Secondary Care Centre of Aga Khan University Hospital.Pakistan journal of medical sciences · 2025Article
- Patient and hospital staff perspectives on introducing pharmacist-led medication reviews at an orthopedic ward: a mixed methods pilot study.International journal of clinical pharmacy · 2025Article
- Impact of Clinical Pharmacist Interventions in Prescribing Errors in Hospitalized Diabetic Patients with Major Polypharmacy.Hospital pharmacy · 2021Article
- Assessment of an electronic patient record system on discharge prescribing errors in a Tertiary University Hospital.BMC medical informatics and decision making · 2021Article
- Practice Transformation Driven through Academic Partnerships.Pharmacy (Basel, Switzerland) · 2020Article
- Pharmacist-Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability.Pharmacy (Basel, Switzerland) · 2019Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThis study aims to investigate the effects on quality of the medicine-related healthcare service provided at hospital discharge after implementing a pharmacist-led patient-centred discharge service.
methodsMedical in-patients ready for discharge and prescribed at least six medicines were eligible for inclusion in this descriptive intervention study. A ward-based clinical pharmacist provided a patient-centred discharge service which comprised medication review (including reconciliation if appropriate), medication counselling and verification of the medication discharge summary plans. Satisfaction with the pharmacist-led interventions was collected by questionnaires and follow-up telephone interviews. A quality audit on the medical information stated in the discharge summary plans was conducted.
resultsA total of 313 medical records were prospectively reviewed by the clinical pharmacist, and 745 medicine-related problems each leading to a clinical recommendation were identified. The total rate of acceptance by the physicians was found to be 84%. The quality audit revealed a significantly higher quality of the medication discharge summary plans sent to primary care regarding content of updated lists of medication after the pharmacist's intervention. The involved physicians stated that contributions from the pharmacist had eased their workload and helped them to obtain a more rational prescribing practice. The interviewed patients felt secure and well-informed about their medicines.
conclusionsContributions from clinical pharmacists can improve both the quality of and satisfaction with the medicine-related healthcare service provided at hospital discharge and secure continuity of medical care at transitions.
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