The effect of a pharmaceutical transitional care program on rehospitalisations in internal medicine patients: an interrupted-time-series study

Table 5 Effect of the COACH program on medication reconciliation interventions (n = 365)

Outcome: drug-related problems	Hospital admission mean/pat (%^d)	Hospital discharge mean/pat (%^d)	Patient counselling mean/pat (%^d)	Total mean/pat (%^d)
Elimination of discrepancies^a	1.65 (62.4)	1.43 (68.2)	0.82 (49.7)	3.90 (89.2)
Optimisation of pharmacotherapy^b	0.10 (9.7)	1.76 (75.1)	0.15 (13.0)	2.02 (80.4)
Optimisation medication handling^c	–	–	4.15 (97.8)	4.15 (97.8)
Total	1.75 (64.1)	3.19 (93.4)	5.12 (98.9)	10.07 (100.0)

^a Examples: omission of pre-admission used diabetes drug started at hospital admission, temporarily discontinued anticoagulant restarted at hospital discharge, patient used a different dose of inhalation medication pre-admission
^b Examples: a laxative added to opioid use at admission, analgesics or protonpumpinhibitor discontinued at discharge as there was no indication anymore, patient states that sedative is no longer needed
^c Examples: questions of patient regarding side effect answered, adherence to medication and helping tools discussed, medication changes explained
^d Percent of patients for whom at least one intervention was registered

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