Pharmacist intervention key in reducing ADEs

May 8, 2006

There is a long paper trail that links a lower rate of adverse drugevents to discharge counseling by pharmacists for hospitalizedpatients. But most health systems don't take advantage of apharmacist's expertise in this area. Proponents of utilizingpharmacists in this capacity are hopeful that the results of a newstudy might change how hospitals make use of pharmacists andthereby reduce the incidence of ADEs.

The evidence-based study out of Brigham & Women's Hospital and the Harvard School of Public Health concludes that pharmacist medication review, patient counseling, and telephone follow-up were associated with a lower rate of preventable ADEs 30 days after hospital discharge. The study was published in a recent edition of Archives of Internal Medicine. Its objectives were:

The study was based on a randomized trial of 178 patients being discharged from the general medicine unit at a large teaching hospital. Patients in the intervention group received pharmacist counseling at discharge and a follow-up telephone call three to five days later.

Comparing trial outcomes 30 days after discharge, preventable ADEs were detected in 11% of patients in the control group and 1% in the intervention group.

The study concludes that pharmacists have the expertise to address DRPs during and after hospitalization. In addition, data from the study revealed that it's probably a good idea to have pharmacists counsel patients at discharge, where they can detect and resolve medication discrepancies and screen for possible non-adherence and ADEs after discharge.

During the interventions, pharmacists identified various types of DRPs. At discharge, counseling pharmacists discovered that the medical team had often misunderstood the patient's pre-admission medication regimen and carried these inaccuracies through to the discharge medication orders. These included 34 missing medications, a different dose or frequency of a medication in 12 cases, and a different medication in the same class in 11 cases.

Pharmacist counseling and follow-up were associated with lower rates of preventable ADEs after discharge-likely through reduction in medication discrepancies. Study authors concluded that greater roles for pharmacists in hospital care should be considered, especially as medication reconciliation becomes mandatory.

David Bates, M.D., professor in the Department of Health Policy and Management at the Harvard School of Public Health and one of the study's authors, said he is optimistic that the study data will have an impact on the use of pharmacists in the real world. "Basically what we found is that having a pharmacist review the medications is associated with fewer injuries to patients related to their drugs after discharge."

But Bates conceded that there are some challenges in getting health systems to adopt this type of policy. For one thing, he said, hospitals don't get paid extra for having pharmacists engage in this type of activity. He did, however, point out that there are plenty of studies that show that patients do often suffer injuries related to drugs, especially right after they go home. "If you have a pharmacist intervene early, that makes the situation better," he said.