Effect of Pharmacist Intervention on 30-Adverse Drug Event after Discharge in Elderly Patients through a Comprehensive Medication Reconciliation: A Randomized Clinical Trial

Polypharmacy can cause drug-related problems, such as potentially inappropriate medication (PIM) use and medication regimen complexity in the elderly. This comprehensive medication reconciliation study was designed as a prospective, open-label, randomized clinical trial with patients aged 65 years or older from July–December 2020. Comprehensive medication reconciliation comprises medication reviews based on the PIM criteria. The discharge of medication was simplified to reduce regimen complexity. Changes in regimen complexity were evaluated using the Korean version of the medication regimen complexity (MRCI-K). Adverse drug events (ADEs) were monitored throughout hospitalization and 30 days after discharge. Of the 32 patients, 34.4% (n = 11) reported ADEs before discharge, and 19.2% (n = 5) ADEs were reported at the 30-day phone call. No ADEs were reported in the intervention group, whereas five events were reported in the control group (p = 0.039) on the 30-day phone call. The intervention group showed a greater score reduction than the control group in terms of the number of medications, MRCI-K, and PIMs. As a result of the pharmacist intervention, we identified the feasibility of pharmacist-led interventions using comprehensive medication reconciliation, including the criteria of the PIMs and the MRCI-K, and the differences in ADEs between the intervention and control groups at the 30-day follow-up after discharge (Clinical trial number: KCT0005994, 03/12/2021).