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Reducing hospital admissions for adverse drug events through coordinated pharmacist care: learning from Hawai’i without a field trip
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  1. Michael A Steinman
  1. Division of Geriatrics, University of California, San Francisco and the San Francisco VA Medical Center, San Francisco, CA 94121, USA
  1. Correspondence to Michael A Steinman, Division of Geriatrics, University of California, San Francisco and the San Francisco VA Medical Center, San Francisco, CA 94121, USA; mike.steinman{at}ucsf.edu

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Adverse drug events among older adults are common and serious. Approximately 9% of all hospital admissions for older adults are attributable to adverse drug reactions.1 Moreover, up to one in five adults experience an adverse drug reaction during hospitalisation,2 3 and approximately 15%–50% of hospitalised older adults will suffer an adverse drug event within 30 days of returning home (with most of these events resulting from medications that were started in the hospital).4–6 If our goal is primum non nocere (‘first, do no harm’), we have substantial opportunities for improvement.

A variety of interventions have been attempted to stem this tide of medication-induced harm, with variable success, and no clear path for hitting the sweet spot of meaningfully improving clinical outcomes related to medication use in a manner than is clinically scalable and cost-effective.7–12 Into this breach step Pellegrin et al with the Pharm2Pharm intervention, outcomes of which are reported in this issue of BMJ Quality and Safety.13 In the Pharm2Pharm programme, hospital-based pharmacists identified inpatients at high risk of medication misadventures, using criteria such as use of multiple medications, presence of high-risk medications such as warfarin or glucose-lowering drugs and history of previous acute care use resulting from medication-related problems.14 The hospital pharmacist then met with the patient to reconcile medications, offer education and facilitate a coordinated hand off to a community pharmacist, selected with patient input. This community pharmacist met with the patient on an as-needed basis for up to a year postdischarge to reconcile medications, assess medication appropriateness, resolve drug therapy problems and notify prescribers of updates to the medication list, all supported by a health information exchange system. This programme was implemented sequentially in 6 of 11 non-federal general hospitals with 50 or more beds in the US state …

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