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Table 2 Fidelity of pharmacists’ interventions

From: Effect of a care transition intervention by pharmacists: an RCT

 

Enhanced

Minimal

P-values

 

n = 311

n = 312

 

Admission medication reconciliation

311 (100%)

312 (100%)

 

Community pharmacy contacted

300 (96.5%)

305(97.8%)

0.34

Discharge counseling completed

235 (75.6%)

235 (75.3%)

0.94

Wallet card completed

309 (99.4%)

308 (98.7%)

0.41

Medication issues identified in hospital

275 (88.4%)

249 (79.8%)

0.003

Post-discharge phone call completed

301 (96.8%)

4 (1.3%)*

 

Discharge care plan faxed to community physician

267 (85.9%)

1 (0.3%)*

 

Discharge care plan faxed to community pharmacist

246 (79.1%)

1 (0.3%)*

 

Discharge care plan included medication recommendations to community physician

207 (66.6%)

NA

 

Discharge care plan medication issues identified by pharmacists†

To Hospital & Community Physicians

To Hospital Physicians

 

  Mean (±SD)

6.6 (±6.8)

3.2 (±4.0)

 

  Total number of issues identified

2063

1012

 

  Dosing or administration

260

131

 

  Indication

754

363

 

  Efficacy

319

101

 

  Cost

103

38

 

  Risk to patient

627

379

 

Discharge care plan recommendations made to physicians†

To Hospital & Community Physicians

To Hospital Physicians

 

  Mean (±SD)

7.1 (±6.6)

3.5 (±3.8)

 

  Total number of recommendations

2220

1077

 

  Discontinue medications

377

195

 

  Add medications

566

256

 

  Change medications

361

151

 

  Disease monitoring

280

56

 

  Follow-up patient

262

134

 

  Patient education

283

239

 

  Adherence education

91

46

 

Time pharmacist spent on each patient (minutes)

210.0 (±93.0)

118.5 (±58.6)

<.0001

  1. *Inadvertent crossover since care plans should not have been sent according to randomization.
  2. †Many but not all medication issues and recommendations were repeated to the community physicians, accounting for almost twice the numbers in the enhanced group.