ArticleInternational journal of clinical pharmacy2023
The impact of pharmacist-led medication reconciliation and interprofessional ward rounds on drug-related problems at hospital discharge.
Article in International journal of clinical pharmacy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Skilled Nursing Facility-to-Home Transitions After Heart Failure Hospitalization: A Mixed-Methods Study of Communication, Self-Care, Medication, and Follow-Up.Circulation. Heart failure · 2026Article
- Polypharmacy in Older Adults: A Narrative Review of Clinical Risks, Deprescribing Strategies, and Interdisciplinary Management.Geriatrics (Basel, Switzerland) · 2026Review
- Community pharmacists' practices and clinical reasoning towards hospital discharge prescription: a study using simulations and retrospective think-aloud methodology.International journal of clinical pharmacy · 2026Article
- Impact of a pharmacist-led elective caesarean section pre-admission clinic on efficiency of pharmacist workflow and patient preparedness for post-operative discharge medication supply: a retrospective observational study.International journal of clinical pharmacy · 2025Observational
- The doMESTIC RISK Tool: Prioritising Home-Care Patients for Clinical Pharmacy Services with the Help of a Delphi Study.Nursing reports (Pavia, Italy) · 2025Article
- Medication reconciliation and seamless care led by clinical pharmacists in Slovenia: a national reimbursed program ensuring safe and effective transition of care.International journal of clinical pharmacy · 2025Article
- Impact of clinical pharmacist involvement on emergency department physicians' work-time distribution: a comparative analysis.Therapeutic advances in drug safety · 2025Article
- Analysis of clinical pharmacists' interventions in a rehabilitation setting.Journal of pharmaceutical policy and practice · 2025Article
- Pharmacist-led interventions for vascular surgery patients: a prospective study on reducing drug-related problems.BMC health services research · 2024Observational
- Optimisation of medication reconciliation using queueing theory: a computer experiment.International journal of clinical pharmacy · 2024Article
- A national survey on assessment of knowledge, perceptions, practice, and barriers among hospital pharmacists towards medication reconciliation in United Arab Emirates.Scientific reports · 2024Article
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Authors and funding
9 authors.
Funding
Abstract
backgroundDuring transitions of care, including hospital discharge, patients are at risk of drug-related problems (DRPs).
aimTo investigate the impact of pharmacist-led services, specifically medication reconciliation at admission and/or interprofessional ward rounds on the number of DRPs at discharge.
methodIn this retrospective, single-center cohort study, we analyzed routinely collected data of patients discharged from internal medicine wards of a regional Swiss hospital that filled their discharge prescriptions in the hospital's community pharmacy between June 2016 and May 2019. Patients receiving one of the two or both pharmacist-led services (Study groups: Best Care = both services; MedRec = medication reconciliation at admission; Ward Round = interprofessional ward round), were compared to patients receiving standard care (Standard Care group). Standard care included medication history taken by a physician and regular ward rounds (physicians and nurses). At discharge, pharmacists reviewed discharge prescriptions filled at the hospital's community pharmacy and documented all DRPs. Multivariable Poisson regression analyzed the independent effects of medication reconciliation and interprofessional ward rounds as single or combined service on the frequency of DRPs.
resultsOverall, 4545 patients with 6072 hospital stays were included in the analysis (Best Care n = 72 hospital stays, MedRec n = 232, Ward Round n = 1262, and Standard Care n = 4506). In 1352 stays (22.3%) one or more DRPs were detected at hospital discharge. The combination of the two pharmacist-led services was associated with statistically significantly less DRPs compared to standard care (relative risk: 0.33; 95% confidence interval: 0.16, 0.65). Pharmacist-led medication reconciliation alone showed a trend towards fewer DRPs (relative risk: 0.75; 95% confidence interval: 0.54, 1.03).
conclusionOur results support the implementation of pharmacist-led medication reconciliation at admission in combination with interprofessional ward rounds to reduce the number of DRPs at hospital discharge.
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