Pharmacist-Guided Medication Reconciliation to Reduce Readmissions

Abstract This chapter explores the impact of pharmacist-guided medication reconciliation on reducing hospital readmissions. In the underlying study, clinicians discharged high-risk patients with more than five medications and scheduled joint follow-up visits with both a physician and a pharmacist. The pharmacist performed medication reconciliation, identified discrepancies, and made recommendations to optimize drug therapy. The study demonstrated that the intervention significantly reduced 30-day readmission rates, with only 9.2% of patients in the intervention group being readmitted compared to 19.5% in the physician-only group. Pharmacists detected 545 medication discrepancies and made 161 drug therapy recommendations among the intervention group. Finally, the chapter concludes that pharmacist involvement in postdischarge visits improves medication management and significantly reduces hospital readmissions, enhancing patient care.