A Pharmacist-Led Randomized Controlled Trial to Assess Adverse Drug Events in Patients Discharged from the Hospital.

Gurwitz JH, Kapoor A, Garber L, et al. Effect of a Multifaceted Clinical Pharmacist Intervention on Medication Safety After Hospitalization in Persons Prescribed High-risk Medications: A Randomized Controlled Trial. JAMA Intern Med. Mar 2021. doi:10.1001/jamainternmed.2020.9285

A randomized clinical trial recently published in JAMA Internal Medicine sought to test the effects of a pharmacist-led intervention to reduce adverse drug events (ADEs) in patients over 50 years recently discharged from the hospital. The trial studied 3 high priority drug classes:

  1. anticoagulants
  2. opioids
  3. diabetes medications

Pharmacists conducted in-home visits, provided educational materials, communicated with the patient’s primary care team, and conducted a follow up phone call with the patient or caregiver 2 weeks after the home visit. The control group only received educational materials. Of the 181 participants in the intervention group, 81 experienced an adverse drug-related incident, while the control group fared similarly (72/180). A second outcome, clinically important medication errors, included potential ADEs (medication-related errors that may not yet have caused injury to a patient, but have the potential to cause future harm if not addressed) and preventable ADEs (a drug-related injury relating to a medication error such as errors in ordering, dispensing, administration, and use or monitoring) was also not different between groups; there was an adjusted 19% reduction in such events among the intervention group but this difference was  not statistically significant (incidence rate ratio 0.81, 95% CI 0.53-1.23). Though pharmacist-led interventions are generally thought to be effective means of promoting medication safety, the current trial did not yield statistically significant benefits. The authors note several limitations including:

  1. engaging the patients once they were discharged rather than in the hospital, potentially leading to missed events
  2. intervention subjects may have been primed to identify and report medication events, thus diluting the apparent effect of the intervention
  3. difficulty reaching the target number of enrolled subjects

The surprising results from this trial suggest a need to unpack the reasons that the intervention did not have the intended effect, including addressing issues of measurement and the intervention itself, and to think critically about what kinds of next-generation interventions may be needed to meaningfully improve outcomes for older adults after hospitalization.

Lead author Dr. Jerry Gurwitz reflects:

“Our study findings should not dampen enthusiasm for developing, testing, and refining interventions to enhance medication safety in older patient populations. Such efforts can be complex and challenging, but patients, healthcare providers, healthcare systems, and payers require a clear understanding of the effectiveness of these interventions. Only then will investments be made to allow them to scale and spread.”

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