Impact of discharge medication counseling in the cardiology unit of a tertiary hospital in Brazil: A randomized controlled trial

Clinics (Sao Paulo). 2018;73:e325. doi: 10.6061/clinics/2018/e325. Epub 2018 Apr 26.


Objectives: This study aimed to evaluate the impact of pharmacist-provided discharge counseling on mortality rate, hospital readmissions, emergency department visits, and medication adherence at 30 days post discharge.

Methods: This randomized controlled trial was approved by the local ethics committee and included patients aged 18 years or older admitted to the cardiology ward of a Brazilian tertiary hospital. The intervention group received a pharmacist-led medication counseling session at discharge and a telephone follow-up three and 15 days after discharge. The outcomes included the number of deaths, hospital readmissions, emergency department visits, and medication adherence. All outcomes were evaluated during a pharmacist-led ambulatory consultation performed 30 days after discharge.

Results: Of 133 patients, 104 were included in the analysis (51 and 53 in the intervention and control groups, respectively). The intervention group had a lower overall readmission rate, number of emergency department visits, and mortality rate, but the differences were not statistically significant (p>0.05). However, the intervention group had a significantly lower readmission rate related to heart disease (0% vs. 11.3%, p=0.027), despite the small sample size. Furthermore, medication counseling contributed significantly to improved medication adherence according to three different tools (p<0.05).

Conclusions: Pharmacist-provided discharge medication counseling resulted in better medication adherence scores and a lower incidence of cardiovascular-associated hospital readmissions, thus representing a useful service for cardiology patients.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Brazil
  • Cardiology Service, Hospital / statistics & numerical data
  • Directive Counseling*
  • Female
  • Heart Diseases / mortality
  • Humans
  • Male
  • Medication Adherence / psychology
  • Middle Aged
  • Patient Discharge / standards*
  • Patient Readmission / statistics & numerical data
  • Pharmacists / psychology*
  • Pharmacists / standards
  • Professional Role / psychology
  • Tertiary Care Centers / statistics & numerical data