%0 Journal Article
%T Pharmacist Clinical Interventions and Discharge Counseling in Medical Rehabilitation Wards in a Local Hospital: A Prospective Trial
%A Angus Chun Kwok Chu
%A Grace Wai Man Young
%A Justin Wade Tenney
%A Pauline Lai Ming Chu
%A Rosanna Nga Suet Ip
%J -
%D 2018
%R https://doi.org/10.3390/geriatrics3030053
%X Abstract Patients undergoing rehabilitation experience numerous changes in medication regimens during care transitions, exposing these patients to an increased risk of drug-related problems (DRPs). A prospective, non-randomized, quasi-experimental study was conducted in medical rehabilitation wards to evaluate the impact of pharmacist-delivered interventions and counseling on 30-day unplanned health care utilization and medication adherence for selected rehabilitation patients. A pharmacist provided medication reconciliation and counseling before discharge. Phone follow-up was completed 30 days after discharge to assess for unplanned health care utilization rate and medication adherence. A total of 85 patients ( n = 43 in prospective intervention group and n = 42 in historical usual care group) were included. Among the intervention group, 23 DRPs were identified in 14 (32.6%) patients, resulting in 51 interventions. The intervention group had a significantly lower unplanned health care utilization rate than the usual care group (25.6% vs. 47.6%, p = 0.035). The risk of unplanned health care utilization was reduced by over 60% (Odds ratio (OR) = 0.378; 95% CI = 0.15¨C0.94). Patients reporting medium to high medication adherence increased from 23.6% to 88.4% 30 days after counseling ( p < 0.05). Pharmacist medication reconciliation and discharge counseling reduced unplanned health care utilization 30 days after discharge and improved medication adherence. View Full-Tex
%K pharmacist
%K pharmacist intervention
%K medication reconciliation
%K discharge counseling
%K drug-related problem
%K readmission
%K unplanned health care utilization
%K medication adherence
%U https://www.mdpi.com/2308-3417/3/3/53