Comprehensive Summary
This single center, prospective, open-label randomized trial evaluated a pharmacist-led transition of care program to reduce emergency department (ED) revisits for patients with medication-related events (MREs). Patients presenting with adverse drug events were enrolled and followed for six months. Of 330 participants, 167 were assigned to the pharmacist intervention group and 163 to usual care (UC). The intervention involved coordinated telephone and written follow-up by an ED pharmacist with the patient’s general practitioner and community pharmacist after discharge. UC consisted of the ED pharmacist’s standard review of the patient’s prior medication history. The primary outcome was the proportion of patients returning to the ED within six months for the same MRE. Secondary outcomes included all-cause and MRE-related hospitalizations, ED visits and medical office visits, and mortality. Significantly fewer patients in the transition-of-care group returned to the ED for the same MRE after six months (5 [3.0%]) vs (36 [22.1%], p < 0.001). Furthermore, significantly fewer all-cause ED visits and MRE-related hospitalizations were observed with pharmacist intervention compared to UC (p < 0.001). Rates of all-cause hospitalization and mortality were similar between groups.
Outcomes and Implications
Medication-related events are a major cause of preventable ED utilization and often reflect gaps in communication during care transitions. This study demonstrates that a pharmacist-led transition of care program can significantly reduce the number of patients with recurrent ED visits and MRE-related hospitalizations. Despite its single-center design, variability in pharmacy services, and difficulties in implementing integrated medical records, the findings demonstrate that such pharmacist-led programs can enhance patient outcomes. Larger multicenter trials are warranted to assess the integration of these programs into diverse health care settings.