A recent scoping review has, for the first time, described pharmacist-led interventions at hospital discharge that reduce readmission rates.
Hospital readmissions frequently stem from medication-related problems, such as prescription errors or poor treatment adherence around transitions of care. Pharmacists, with their expertise in medication management, are uniquely positioned to address these gaps during the discharge process.
This study addressed the growing need to identify specific interventions that mitigate factors contributing to avoidable readmissions and lessen their overall impact. The authors synthesised data from 25 articles focusing on pharmacist-driven initiatives such as medication reconciliation, individualised patient education and ongoing collaboration with healthcare teams.
Study designs of included articles ranged from retrospective cohort analyses to randomised controlled trials (RCTs). Some studies incorporated pharmacists into broader care teams, while others examined direct pharmacist-patient interactions, underscoring the flexibility of pharmacist-led interventions across different healthcare environments.
The review revealed a wide variety of pharmacist-driven strategies at the time of discharge that successfully lowered readmission rates: medication reconciliation, patient education, medication reviews and arranging post-discharge follow-up.
In most cases, these activities were combined or integrated into broader interdisciplinary care, implying the need for a more comprehensive approach to effectively decrease readmissions.
Several articles showed that structured post-discharge follow-up further reduced readmissions, highlighting the value of ongoing support.
All included RCTs employed more than one intervention, suggesting synergy in combining interventions.
Translating the findings of this study to practice, hospital pharmacists should consider adopting a multi-component strategy at discharge, with patient counselling emerging as the most common intervention.
The study authors indicated how this comprehensive review should encourage ‘pharmacy policymakers [to] use these findings to define or refine pharmacists’ interventions at hospital discharge aimed at reducing readmissions’. They went on to say that by adopting such an approach, ‘pharmacists can play a crucial role in reducing the financial burden of hospital readmissions and improving patients’ health outcomes’.
Future studies should standardise the specific components of pharmacist-led interventions, including their sequence, timing and synergy with other healthcare professionals, the authors concluded.
Cost-effectiveness and sustainability analyses would also inform resource allocation decisions. Expanding on the understanding of these interventions will hopefully lead to safer transitions of care and improved patient outcomes, they added.
Reference
Weber C et al. Pharmacist-led interventions at hospital discharge: a scoping review of studies demonstrating reduced readmission rates. Int J Clin Pharm. 2025 Feb;47(1):15-30. doi: 10.1007/s11096-024-01821-y.
