Abstract
Importance Medication-related events (MREs) are a frequent cause of emergency department (ED) visits and patient harm. Objective To assess the efficacy of a pharmacist-led transition of care program in reducing ED visits related to the same MRE at 6 months compared with usual care. Design, Setting, and Participants This prospective, open-label, parallel-group randomized clinical trial was conducted from November 2018 to July 2021 at the ED of Montpellier University Hospital, Montpellier, France, with a 6-month follow-up period. Adult patients with an MRE detected at ED admission were included. MREs included adverse drug events with or without misuse and medication nonadherence with unfavorable clinical evolution. End points were assessed blindly from the randomization arm. Data were analyzed from January 2022 to March 2024. Intervention Participants were randomized to a pharmacist-led transition of care program or usual care. Usual care included the ED pharmacist carrying out a medication history. In the transition of care group, ED pharmacists additionally made a postdischarge telephone call to the general practitioner (GP) and community pharmacist, along with a letter, notifying them about MRE type, suspected medication, and management recommendations. Main Outcomes and Measures The primary outcome was the proportion of patients with an ED visit for the same MRE at 6 months (same symptom and medication involved). Secondary outcomes included proportions of all-cause and MRE-related ED visits, hospitalizations, deaths, and medical office visits. Results Among 330 patients analyzed, 187 (56.7%) were female, the median (IQR) age was 71 (50-83) years, and the median (IQR) home medications count was 6 (3-10). A total of 167 patients were randomized to the transition of care group and 163 to the control group. At 6 months, fewer participants in the transition of care group had ED visits related to the same MRE (5 [3.0%] vs 36 [22.1%]; risk difference [RD], −19.1 percentage points; 95% CI, −26.0 to −12.2; P < .001), all-cause ED visits (35 [21.0%] vs 57 [35.0%]; RD, −14.0 percentage points; 95% CI, −23.6 to −4.4), hospitalization related to the same MRE (3 [1.8%] vs 29 [17.8%]; RD, −16.0 percentage points; 95% CI, −22.2 to −9.8), and more GP office visits (88 of 158 [55.7%] vs 26 of 146 [17.8%]; RD, 37.9 percentage points; 95% CI, 28.0 to 47.8) and specialist office visits (67 of 158 [42.4%] vs 35 of 146 [24.0%]; RD, 18.4 percentage points; 95% CI, 8.1 to 28.8) related to the same MRE. All-cause hospitalization and death were similar between groups. Conclusions and Relevance In this randomized clinical trial, a pharmacist-led transitional care intervention in the ED among patients with MRE significantly reduced ED visits and hospitalizations for the same MRE. If replicated in subsequent trials, this strategy offers a novel approach for reducing drug-related harms. Trial Registration ClinicalTrials.gov Identifier: NCT03725046