Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission: A Randomized Clinical Trial
Open accessAbstract
Importance: Hospital readmissions are common among patients receiving multiple medications, with considerable costs to the patients and society. Objective: To determine whether a multifaceted pharmacist intervention based on medication review, patient interview, and follow-up can reduce the number of readmissions and emergency department (ED) visits. Design, Setting, and Participants: This randomized clinical multicenter study (Odense Pharmacist Trial Investigating Medication Interventions at Sector Transfer [OPTIMIST]) enrolled patients from September 1, 2013, through April 23, 2015, with a follow-up of 6 months completed on October 31, 2015. Consecutive medical patients in an acute admission ward who were 18 years or older and who used 5 or more medications were invited to participate. Of 1873 patients invited to participate, 1499 (80.0%) accepted. The medication review and patient interview were conducted in the hospital and followed up in collaboration with primary care. Analysis was based on intention to treat. Interventions: The patients were randomized into 3 groups receiving usual care (no intervention), a basic intervention (medication review), and an extended intervention (medication review, 3 motivational interviews, and follow-up with the primary care physician, pharmacy, and nursing home). Main Outcomes and Measures: The prespecified primary outcomes were readmission within 30 or 180 days and ED visits within 180 days. The primary composite end point was readmission or an ED visit within 180 days. Secondary outcomes were drug-related readmissions within 30 and 180 days after inclusion, and all-cause mortality and drug-related mortality. Results: A total of 1467 patients (679 men [46.3%] and 788 women [53.7%]; median age, 72 years; interquartile range, 63-80 years) were part of the primary analysis, including 498 randomized to usual care, 493 randomized to the basic intervention, and 476 randomized to the extended intervention. The extended intervention had a significant effect on the numbers of patients who were readmitted within 30 days (hazard ratio [HR], 0.62; 95% CI, 0.46-0.84) or within 180 days (HR, 0.75; 95% CI, 0.62-0.90) after inclusion and on the number of patients who experienced the primary composite end point (HR, 0.77; 95% CI, 0.64-0.93). The study showed a nonsignificant reduction in drug-related readmissions within 30 days (HR, 0.65; 95% CI, 0.39-1.09) and within 180 days (HR, 0.80; 95% CI, 0.59-1.08) after inclusion and in deaths (HR, 0.83; 95% CI, 0.22-3.11). The number needed to treat to achieve the primary composite outcome for the extended intervention (vs usual care) was 12. Conclusions and Relevance: A multifaceted clinical pharmacist intervention may reduce the number of ED visits and hospital readmissions. Trial Registration: clinicaltrials.gov Identifier: NCT03079375.
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The literature review found one systematic review and meta-analysis containing six RCTs and one additional RCT of vitamin C.
“Our literature review found one systematic review and meta-analysis (522) (containing six RCTs) and one additional RCT (523).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [522]
The Abstract identifies this paper as an additional randomized clinical trial, so it supports the RCT citation. But its intervention was pharmacist-led medication review, interviews, and follow-up—not vitamin C. The six-RCT meta-analysis is attached to a different citation (522), not this paper. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMedication reconciliation has been associated with fewer medication errors and may help reduce hospital readmission.
“Medication reconciliation has been associated with fewer medication errors [598, 612] and may help reduce hospital readmission [613, 614].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [613]
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
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- Authors
- Ravn-Nielsen, L. V., Duckert, M.-L., Lund, M. L., Henriksen, J. P., Nielsen, M. L., Eriksen, C. S., Buck, T. C., Pottegård, A., Hansen, M. R., & Hallas, J.
- Affiliations
- Hospital Pharmacy of Funen, Clinical Pharmacy Department, Odense University Hospital, Odense, Denmark
- Odense University Hospital (DK)
- Svendborg Sygehus (DK)
- Mental Health Services (DK)
- St Thomas Pharmacy, Vejle, Denmark
- University of Southern Denmark (DK)
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2018-03-01
- Volume
- 178
- Issue
- 3
- Pages
- 375
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC5885912
- OpenAlex
- W2793086396
- Cited by
- 310
- References
- 52
- Citations by year
- 2026: 24 · 2025: 23 · 2024: 48 · 2023: 42 · 2022: 36 · 2021: 45 · 2020: 41 · 2019: 31 · 2018: 19
- FWCI
- 18.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- hospital readmission, pharmacist intervention, medication review, polypharmacy, motivational interviewing, emergency department visits, drug-related deaths, primary care follow-up, nursing homes, drug safety, patient interviews, secondary prevention, all-cause mortality, medication adherence
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Length of Stay, Male, Middle Aged, Patient Care Team, Patient Education as Topic, Patient Readmission, Pharmacy Service, Hospital, Drug Prescriptions, Medication Reconciliation
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