Medication Reconciliation at Discharge: Impact on Patient's Care
Condition: Medication Reconciliation
Study type: Interventional

Summary: 
      Patient's discharge from hospital is associated with iatrogenic events for 12 to 17% of
      patients. This risk may be linked with discontinuity of care between hospital physicians and
      Primary Care Physician (PCP). The investigators aim to assess in this study the impact of
      medication reconciliation at discharge associated with a patient's counseling session, both
      provided by a pharmacist, on patient's care after discharge. To demonstrate the interest of
      medication reconciliation at discharge we expect a reduction by 15% of the number of
      prescription changes not maintained by the PCP after discharge.
    

Detailed description: 
      Patient's discharge from hospital is associated with iatrogenic events for 12 to 17% of
      patients and may lead to further hospitalization. This risk may be linked with discontinuity
      of care between hospital physicians and Primary Care Physician (PCP) and from discrepancies
      between patient's current medications and drugs prescribed at discharge.

      Preventing adverse drug events (ADEs) remains a patient safety priority not only in hospitals
      but also across the continuum of care for patients. Implementing medication reconciliation at
      all transitions in care is an effective strategy for preventing discrepancies and ADEs.
      Medication reconciliation prevents and corrects medication errors by promoting transmissions
      of complete and accurate information about medicines.

      Furthermore, ADEs may be the result of a failure to understand and manage post-discharge care
      needs and can lead to hospital readmission.

      We assume that medication reconciliation at discharge, secondarily transmitted to the PCP
      with a discharge counseling session between the patient and a clinical pharmacist could have
      a positive impact on the maintenance of therapeutic optimization decided by in-hospital
      practitioners.

      In order to evaluate this assumption, we will conduct a randomized controlled study on 120
      patients (as a reduction by 15% of the number of prescription changes not maintained by the
      PCP after discharge is expected).

      The follow-up will last 1 month after discharge from hospital. The first prescription from
      the PCP will be collected and analyzed. In addition, patients and PCPs will be contacted by
      the pharmacist to answer specific questionnaires.

      The primary objective of the study is to assess the impact of medication reconciliation at
      discharge associated with a patient's counseling session, both provided by a pharmacist, on
      patient's care after discharge.
    

Intervention name(s): Reconciliation
Intervention type(s): Behavioral
Intervention description(s): In addition to standard healthcare procedures, the pharmacist will analyze discharge prescriptions and proceed to medication reconciliation. A patient's counseling session will also be provided by the pharmacist. A reconciliation mail will be addressed to the PCP.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Monocenter, randomized, controlled, pilot study.
Masking: None (Open Label)
Primary purpose: Treatment