Sunil Kripalani, MD, MSc; Christianne L. Roumie, MD, MPH; Anuj K. Dalal, MD; Courtney Cawthon, MPH; Alexandra Businger, BA; Svetlana K. Eden, MSc; Ayumi Shintani, PhD, MPH; Kelly Cunningham Sponsler, MD; L. Jeff Harris, MD; Cecelia Theobald, MD; Robert L. Huang, MD, MPH; Danielle Scheurer, MD, MSc; Susan Hunt, MD; Terry A. Jacobson, MD; Kimberly J. Rask, MD, PhD; Viola Vaccarino, MD, PhD; Tejal K. Gandhi, MD, MPH; David W. Bates, MD, MSc; Mark V. Williams, MD; Jeffrey L. Schnipper, MD, MPH; for the PILL-CVD (Pharmacist Intervention for Low Literacy in Cardiovascular Disease) Study Group
Grant Support: By National Heart, Lung, and Blood Institute grant R01 HL089755 (Dr. Kripalani) and in part by National Heart, Lung, and Blood Institute grant K23 HL077597 (Dr. Kripalani); National Heart, Lung, and Blood Institute grant K08 HL072806 (Dr. Schnipper); Veterans Affairs Career Development Award 04-342-2 (Dr. Roumie); and National Center for Research Resources grant UL1 RR024975 (Dr. Bernard).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2442.
Reproducible Research Statement:Study protocol, data set, and statistical code: Available from Dr. Kripalani (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Sunil Kripalani, MD, MSc, Department of Medicine, Vanderbilt University, 1215 21st Avenue South, Suite 6000 Medical Center East, Nashville, TN 37232; e-mail, email@example.com.
Current Author Addresses: Dr. Kripalani, Ms. Cawthon, and Dr. Cunningham Sponsler: 1215 21st Avenue South, MCE 6000–HSR, Nashville, TN 37232-8300.
Dr. Roumie: Tennessee Valley Healthcare System, 1310 24th Avenue South GRECC, Nashville, TN 37212.
Dr. Dalal: Brigham and Women's Hospital, PBB-B4-428, 15 Francis Street, Boston, MA 02115.
Ms. Businger and Dr. Schnipper: Brigham and Women's Hospital, Division of General Medicine and Primary Care, 1620 Tremont Street, 3rd Floor, Boston, MA 02120-1613.
Ms. Eden and Dr. Shintani: Vanderbilt University School of Medicine, Department of Biostatistics, S-2323 Medical Center North, Nashville, TN 37232-2158.
Dr. Harris: 2336 MacGruder Cove, Memphis, TN 38119.
Dr. Theobald: 113 Bowling Avenue, Nashville, TN 37205.
Dr. Huang: 1223 Longholm Court, Chattanooga, TN 37405.
Dr. Scheurer: Medical University of South Carolina, 135 Rutledge Avenue, Room 1224, Charleston, SC 29425.
Dr. Hunt: University of Washington Medical Center, Department of Medicine, Box 356429, Seattle, WA 98195-6429.
Dr. Jacobson: Emory University, 49 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303.
Dr. Rask: Emory University Rollins School of Public Health, 1518 Clifton Road, Room 636, Atlanta, GA 30322.
Dr. Vaccarino: Emory University School of Public Health, 1518 Clifton Road, Room 3011, Atlanta, GA 30322.
Dr. Gandhi: Partners Healthcare, 115 Fourth Avenue, Needham, MA 02492.
Dr. Bates: Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120-1613.
Dr. Williams: Northwestern University Feinberg School of Medicine, 211 East Ontario Street, Suite 700, Chicago, IL 60611.
Author Contributions: Conception and design: S. Kripalani, T.A. Jacobson, K.J. Rask, T.K. Gandhi, D.W. Bates, J.L. Schnipper.
Analysis and interpretation of the data: S. Kripalani, C.L. Roumie, A. Dalal, A. Businger, S.K. Eden, A. Shintani, L.J. Harris, D. Scheurer, T.A. Jacobson, K.J. Rask, V. Vaccarino, T.K. Gandhi, M.V. Williams, J.L. Schnipper.
Drafting of the article: S. Kripalani, A. Dalal, C. Cawthon, S.K. Eden, T.A. Jacobson, K.J. Rask, M.V. Williams.
Critical revision of the article for important intellectual content: S. Kripalani, C.L. Roumie, C. Cawthon, A. Shintani, K. Cunningham Sponsler, T.A. Jacobson, K.J. Rask, V. Vaccarino, T.K. Gandhi, D.W. Bates, M.V. Williams, J.L. Schnipper.
Final approval of the article: S. Kripalani, C.L. Roumie, A. Dalal, A. Businger, K. Cunningham Sponsler, C. Theobald, D. Scheurer, T.A. Jacobson, K.J. Rask, V. Vaccarino, T.K. Gandhi, D.W. Bates, J.L. Schnipper.
Provision of study materials or patients: S. Kripalani, D.W. Bates.
Statistical expertise: S. Kripalani, S.K. Eden, A. Shintani, V. Vaccarino.
Obtaining of funding: S. Kripalani, J.L. Schnipper.
Administrative, technical, or logistical support: C.L. Roumie, V. Vaccarino.
Collection and assembly of data: S. Kripalani, A. Dalal, C. Cawthon, A. Businger, K. Cunningham Sponsler, C. Theobald, R.L. Huang, D. Scheurer, S. Hunt, T.K. Gandhi, J.L. Schnipper.
Kripalani S, Roumie CL, Dalal AK, Cawthon C, Businger A, Eden SK, et al. Effect of a Pharmacist Intervention on Clinically Important Medication Errors After Hospital Discharge: A Randomized Trial. Ann Intern Med. 2012;157:1-10. doi: 10.7326/0003-4819-157-1-201207030-00003
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Published: Ann Intern Med. 2012;157(1):1-10.
Clinically important medication errors are common after hospital discharge. They include preventable or ameliorable adverse drug events (ADEs), as well as medication discrepancies or nonadherence with high potential for future harm (potential ADEs).
To determine the effect of a tailored intervention on the occurrence of clinically important medication errors after hospital discharge.
Randomized, controlled trial with concealed allocation and blinded outcome assessors. (ClinicalTrials.gov registration number: NCT00632021)
Two tertiary care academic hospitals.
Adults hospitalized with acute coronary syndromes or acute decompensated heart failure.
Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge.
The primary outcome was the number of clinically important medication errors per patient during the first 30 days after hospital discharge. Secondary outcomes included preventable or ameliorable ADEs, as well as potential ADEs.
Among 851 participants, 432 (50.8%) had 1 or more clinically important medication errors; 22.9% of such errors were judged to be serious and 1.8% life-threatening. Adverse drug events occurred in 258 patients (30.3%) and potential ADEs in 253 patients (29.7%). The intervention did not significantly alter the per-patient number of clinically important medication errors (unadjusted incidence rate ratio, 0.92 [95% CI, 0.77 to 1.10]) or ADEs (unadjusted incidence rate ratio, 1.09 [CI, 0.86 to 1.39]). Patients in the intervention group tended to have fewer potential ADEs (unadjusted incidence rate ratio, 0.80 [CI, 0.61 to 1.04]).
The characteristics of the study hospitals and participants may limit generalizability.
Clinically important medication errors were present among one half of patients after hospital discharge and were not significantly reduced by a health-literacy–sensitive, pharmacist-delivered intervention.
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