Pharmacist emergency department care reduces future visits and hospitalizations

Medication-related events are a common cause of emergency department (ED) visits and patient harm. They affect 25% of outpatients and account for 8%-to-16% of ED visits. Medication-related events occur in 19% of hospitalized patients, during hospital stays or after discharge, with almost one-third being preventable. They also contribute to subsequent ED visits in 33% of patients within 30 days of hospital discharge. Repeated medication-related events are of particular concern, with retrospective studies suggesting that 75% of repeated events could be avoided.Transitions of care, particularly from hospital to home, are critical periods for medication-related events. Pharmacist-led interventions, including medication reconciliation and transitional care programs, have shown promise in reducing medication discrepancies, ED visits and readmissions, although randomized clinical trials have yielded mixed results. To further investigate this issue, a new study evaluated the efficacy of a pharmacist-initiated multidisciplinary transition of care program. The program targeted patients admitted to the ED for a medication-related event and determined whether subsequent ED visits related to the same medication-related event were reduced with a pharmacist-led intervention compared with usual care.The prospective, open-label, parallel-group randomized clinical trial was conducted in France, in the ED of Montpellier University Hospital. Adults with a medication-related event detected at ED admission were included in the study. Medication-related events included adverse drug events with or without misuse or medication nonadherence. 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 thetransition of care group, ED pharmacists additionally made a post-discharge telephone call and sent a letter notifying the general practitioner and community pharmacist about the medication-related event type, suspected medication and management recommendations. About 60 minutes of additional time per patient was required for the pharmacist to complete the letter and telephone call.The primary outcome was the proportion of patients with an ED visit for the same medication-related event at six months (i.e., same symptom and medication involved). Secondary outcomes included proportions of all-cause and medication-related event ED visits, hospitalizations, deaths and medical office visits.Results showed the following:The analysis included 330 patients (56.7% female, median age 71 years, median number of home medications was 6).A total of 167 patients were randomized to the transition of care group and 163 to the control group.At six months, fewer participants in the transition of care group had:ED visits related to the same medication-related event (5 [3.0%] vs 36 [22.1%]; risk difference [RD], −19.1 percentage points; 95%CI, −26.0 to −12.2; p < 0.001)all-cause ED visits (35 [21.0%] vs 57 [35.0%]; RD, −14.0 percentage points; 95%CI, −23.6 to −4.4)hospitalizations related to the same medication-related event (3 [1.8%] vs 29 [17.8%]; RD, −16.0 percentage points; 95%CI, −22.2 to −9.8).At six months, the transition of care group experienced a significant increase in the following related to the same MRE:general practitioner medical visits (88 of 158 [55.7%] vs 26 of 146 [17.8%]; risk difference, 37.9 percentage points; 95%CI, 28.0-47.8)specialist medical visits (67 of 158 [42.4%] vs 35 of 146 [24.0%]; risk difference, 18.4 percentage points; 95%CI, 8.1-28.8).Patients in the transition of care group had significantly more office visits related to the same medication-related event than those in the control group but fewer ED visits and shorter hospital lengths of stay. Mean medical costs related to the medication-related event were lower in the transition of care group (US $189.7; 95% CI, 114.0–265.3 vs US $1663.6; 95%CI, 434.8–2892.4; risk difference, US $1473.9; 95% CI, −2704.9 to −242.9) due to less expensive costs for ED visits and hospitalization despite higher costs of medical office visits.All-cause hospitalization and death were similar between groups.The investigators conclude that in this randomized clinical trial, a pharmacist-led transitional care intervention in the ED among patients with medication-related events significantly reduced ED visits and hospitalizations for the same medication-related event. The authors stress that by implementing a structured process of medication-related event detection and early communication with primary care providers, the pharmacist-led intervention facilitated better continuity of care, leading to improved patient outcomes and reduced hospital healthcare utilization. If these results can be replicated in subsequent trials, the authors believe that this strategy offers a novel approach for reducing drug-related harms.Reference:Villiet M, Laureau M, Perier D, et al. Emergency department visits for medication-related events with vs without pharmacist intervention. The URGEIM randomized clinical trial. JAMA Intern Med 2025. Published online April 28, 2025. (accessed April 29, 2025).

Pharmacist emergency department care reduces future visits and hospitalizations

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