Pharmaceutical intervention upon hospital discharge to strengthen understanding and adherence to pharmacological treatment

Farm Hosp. May-Jun 2012;36(3):118-23. doi: 10.1016/j.farma.2011.02.003. Epub 2011 Jul 27.
[Article in English, Spanish]


Objective: To determine the effectiveness of a pharmaceutical intervention with the patient upon hospital discharge, to improve understanding of pharmaceutical treatment and, as a consequence, improve adherence to prescribed regimens at home. To observe whether this intervention has an impact on the number of hospital admissions.

Methods: Experimental, controlled, randomised study with two parallel groups. One-hundred polymedicated internal medicine patients were included. Routine clinical practice was performed on the control group. For the intervention group, whether patient or carer (in the case of dependent patients), a pharmacist explained the drugs prescribed giving the patient a personalised medication timetable. Furthermore, the pharmacist explained why each drug had been prescribed, how to take it and why it was important to take the medication correctly. After seven days, all patients or carers were asked to complete a questionnaire about their treatment by telephone. The responses obtained were compared with the prescription upon discharge and discrepancies were recorded. We consulted the hospital's computer records to check for admissions thirty and sixty days following discharge.

Results: A week following hospital discharge, 70.7% of the intervention group were taking all of their medication in accordance with the prescribed regimen, whereas 19.5% of the control group was (P < .001). Three (7.3%) patients from the intervention group and 10 patients (24.4%) from the control group were readmitted a month following hospital discharge (P < .05). After two months, 3 (7.2%) patients from the intervention group and 13 (31.7%) from the control group had been readmitted (P < .01).

Conclusions: The pharmacist's intervention upon discharge has helped increase the percentage of patients that understood and took their medication correctly in accordance with their prescription. The number of hospital readmissions in the intervention group has also reduced.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aftercare / methods*
  • Aged
  • Aged, 80 and over
  • Caregivers / psychology
  • Directive Counseling*
  • Drug Administration Schedule
  • Female
  • Humans
  • Male
  • Medication Adherence*
  • Medication Errors / prevention & control
  • Patient Discharge*
  • Patient Education as Topic / methods*
  • Patient Readmission / statistics & numerical data
  • Patients / psychology
  • Pharmacists
  • Pharmacy Service, Hospital*
  • Polypharmacy
  • Professional Role
  • Surveys and Questionnaires
  • Telephone