***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To describe the incidence of adverse drug events ( ADEs ) , preventable ADEs , and ameliorable ADEs occurring after hospital discharge and their associated risk factors . DESIGN : Prospect i ve cohort study . SETTING : Urban academic health sciences center . PATIENTS : Consecutive patients discharged home from the general medical service . INTERVENTIONS : We determined posthospital outcomes approximately 24 days following discharge by performing a chart review and telephone interview . Using the telephone interview , we identified new or worsening symptoms , the patient ’s health system use , and re collection of processes of care . Posthospital outcomes were judged by 2 internists independently . RESULTS : Four hundred of 581 potentially eligible patients were evaluated . Of the 400 patients , 45 developed an ADE ( incidence , 11 % ; 95 % confidence interval [ CI ] , 8 % to 14 % ) . Of these , 27 % were preventable and 33 % were ameliorable . Injuries were significant in 32 patients , serious in 6 , and life threatening in 7 . Patients were less likely to experience an ADE if they recalled having side effects of prescribed medications explained ( OR , 0.4 ; 95 % CI , 0.2 to 0.8 ) . The risk of ADE per prescription was highest for corticosteroids , anticoagulants , antibiotics , analgesics , and cardiovascular medications . Risk increased with prescription number . Failure to monitor was an especially common cause of preventable and ameliorable ADEs . CONCLUSION : Following discharge , ADEs were common and many were preventable or ameliorable . Medication side effects should be discussed , and interventions should include better monitoring and target patients receiving specific drug classes or multiple medications OBJECTIVES to investigate the effectiveness of a  pharmacy discharge plan  in elderly hospitalized patients . DESIGN r and omized controlled trial . SUBJECTS AND SETTING S we r and omized patients aged 75 years and older on four or more medicines who had been discharged from three acute general and one long-stay hospital to a pharmacy intervention or usual care . INTERVENTIONS the hospital pharmacist developed discharge plans which gave details of medication and support required by the patient . A copy was given to the patient and to all relevant professionals and carers . This was followed by a domiciliary assessment by a community pharmacist . In the control group , patients were discharged from hospital following st and ard procedures that included a discharge letter to the general practitioner listing current medications . OUTCOMES the primary outcome was re-admission to hospital within 6 months . Secondary outcomes included the number of deaths , attendance at hospital outpatient clinics and general practice and proportion of days in hospital over the follow-up period , together with patients ' general well-being , satisfaction with the service and knowledge of and adherence to prescribed medication . RESULTS we recruited 362 patients , of whom 181 were r and omized to each group . We collected hospital and general practice data on at least 91 and 72 % of patients respectively at each follow-up point and interviewed between 43 and 90 % of the study subjects . There were no significant differences between the groups in the proportion of patients re-admitted to hospital between baseline and 3 months or 3 and 6 months . There were no significant differences in any of the secondary outcomes . CONCLUSIONS we found no evidence to suggest that the co-ordinated hospital and community pharmacy care discharge plans in elderly patients in this study influence outcomes BACKGROUND Hospitalization and subsequent discharge home often involve discontinuity of care , multiple changes in medication regimens , and inadequate patient education , which can lead to adverse drug events ( ADEs ) and avoidable health care utilization . Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and follow-up by pharmacists on preventable ADEs . METHODS We conducted a r and omized trial of 178 patients being discharged home from the general medicine service at a large teaching hospital . Patients in the intervention group received pharmacist counseling at discharge and a follow-up telephone call 3 to 5 days later . Interventions focused on clarifying medication regimens ; review ing indications , directions , and potential side effects of medications ; screening for barriers to adherence and early side effects ; and providing patient counseling and /or physician feedback when appropriate . The primary outcome was rate of preventable ADEs . RESULTS Pharmacists observed the following drug-related problems in the intervention group : unexplained discrepancies between patients ' preadmission medication regimens and discharge medication orders in 49 % of patients , unexplained discrepancies between discharge medication lists and postdischarge regimens in 29 % of patients , and medication nonadherence in 23 % . Comparing trial outcomes 30 days after discharge , preventable ADEs were detected in 11 % of patients in the control group and 1 % of patients in the intervention group ( P = .01 ) . No differences were found between groups in total ADEs or total health care utilization . CONCLUSIONS Pharmacist medication review , patient counseling , and telephone follow-up were associated with a lower rate of preventable ADEs 30 days after hospital discharge . Medication discrepancies before and after discharge were common targets of intervention BACKGROUND Clinical ly 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 ) . OBJECTIVE To determine the effect of a tailored intervention on the occurrence of clinical ly important medication errors after hospital discharge . DESIGN R and omized , controlled trial with concealed allocation and blinded outcome assessors . ( Clinical Trials.gov registration number : NCT00632021 ) SETTING Two tertiary care academic hospitals . PATIENTS Adults hospitalized with acute coronary syndromes or acute decompensated heart failure . INTERVENTION Pharmacist-assisted medication reconciliation , inpatient pharmacist counseling , low-literacy adherence aids , and individualized telephone follow-up after discharge . MEASUREMENTS The primary outcome was the number of clinical ly 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 . RESULTS Among 851 participants , 432 ( 50.8 % ) had 1 or more clinical ly 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 clinical ly 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 ] ) . LIMITATION The characteristics of the study hospitals and participants may limit generalizability . CONCLUSION Clinical ly 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 . PRIMARY FUNDING SOURCE National Heart , Lung , and Blood Institute BACKGROUND Patients with complex care needs who require care across different health care setting s are vulnerable to experiencing serious quality problems . A care transitions intervention design ed to encourage patients and their caregivers to assert a more active role during care transitions may reduce rehospitalization rates . METHODS R and omized controlled trial . Between September 1 , 2002 , and August 31 , 2003 , patients were identified at the time of hospitalization and were r and omized to receive the intervention or usual care .  The setting was a large integrated delivery system located in Colorado . Subjects ( N = 750 ) included community-dwelling adults 65 years or older admitted to the study hospital with 1 of 11 selected conditions . Intervention patients received ( 1 ) tools to promote cross-site communication , ( 2 ) encouragement to take a more active role in their care and to assert their preferences , and ( 3 ) continuity across setting s and guidance from a " transition coach . "  Rates of rehospitalization were measured at 30 , 90 , and 180 days . RESULTS Intervention patients had lower rehospitalization rates at 30 days ( 8.3 vs 11.9 , P = .048 ) and at 90 days ( 16.7 vs 22.5 , P = .04 ) than control subjects . Intervention patients had lower rehospitalization rates for the same condition that precipitated the index hospitalization at 90 days ( 5.3 vs 9.8 , P = .04 ) and at 180 days ( 8.6 vs 13.9 , P = .046 ) than controls . The mean hospital costs were lower for intervention patients ( $ 2058 ) vs controls ( $ 2546 ) at 180 days ( log-transformed P = .049 ) . CONCLUSION Coaching chronically ill older patients and their caregivers to ensure that their needs are met during care transitions may reduce the rates of subsequent rehospitalization BACKGROUND Patients 80 years or older are underrepresented in scientific studies . The objective of this study was to investigate the effectiveness of interventions performed by ward-based pharmacists in reducing morbidity and use of hospital care among older patients . METHODS A r and omized controlled study of patients 80 years or older was conducted at the University Hospital of Uppsala , Uppsala , Sweden . Four hundred patients were recruited consecutively between October 1 , 2005 , and June 30 , 2006 , and were r and omized to control ( n = 201 ) and intervention ( n = 199 ) groups . The interventions were performed by ward-based pharmacists . The control group received st and ard care without direct involvement of pharmacists at the ward level . The primary outcome measure was the frequency of hospital visits ( emergency department and readmissions [ total and drug-related ] ) during the 12-month follow-up period . RESULTS Three hundred sixty-eight patients ( 182 in the intervention group and 186 in the control group ) were analyzed . For the intervention group , there was a 16 % reduction in all visits to the hospital ( quotient , 1.88 vs 2.24 ; estimate , 0.84 ; 95 % confidence interval [ CI ] , 0.72 - 0.99 ) and a 47 % reduction in visits to the emergency department ( quotient , 0.35 vs 0.66 ; estimate , 0.53 ; 95 % CI , 0.37 - 0.75 ) . Drug-related readmissions were reduced by 80 % ( quotient , 0.06 vs 0.32 ; estimate , 0.20 ; 95 % CI , 0.10 - 0.41 ) . After inclusion of the intervention costs , the total cost per patient in the intervention group was $ 230 lower than that in the control group . CONCLUSION If implemented on a population basis , the addition of pharmacists to health care teams would lead to major reductions in morbidity and health care costs OBJECTIVE To determine if providing a way to cancel pre-admission prescriptions would reduce the number of active drug prescriptions ( RXs ) at discharge . DESIGN A r and omized non-blinded clinical trial . SETTING Inpatient acute medical service of a university affiliated Veterans Administration medical center . PARTICIPANTS Twelve medicine ward teams were r and omized to control and intervention groups . Patients controlled had been discharged from these teams during 12 weeks and were receiving outpatient medications from this facility at hospital admission ; control = 180 , intervention = 168 . INTERVENTION At discharge , intervention teams used a computer-generated drug list to cancel or renew previous outpatient RXs or to prescribe new medications . Control teams could not cancel outpatient drugs and wrote all medications on individual prescriptions . MEASUREMENTS The difference between admission and discharge RXs . RESULTS There were no significant differences in patients ' age , sex , race , Charlson Index ( CI ) , or LOS between patient groups at discharge . The intervention group had fewer RXs on admission ( 5.4 vs 6.2 , P < .05 ) and at discharge was not significantly different ( 2.9 vs 2.9 , P = .87 ) from the control group . CONCLUSIONS Providing a method for canceling pre-admission medications did not reduce the number of RXs at discharge . Further research is needed to evaluate the appropriateness of the large increase in RXs from admission to discharge for patients in acute hospital setting PURPOSE The effect of a medication discharge plan ( MDP ) on the rate of medication discrepancies between hospital and outpatient setting s was evaluated . METHODS In a pragmatic , open , r and omized , controlled trial ,  MDPs were completed for all patients before discharge from the hospital . Patients were then assigned to either an  MDP group , for whom MDPs were sent to community pharmacies and treating physicians , or a usual care group , for whom an MDP was not sent . Discrepancies between MDPs and community pharmacy dispensing records and medication use reported by patients during a telephone interview were documented . The percentage of patients with dis 
    Output:
    
The majority of studies found improvements in process measures .
Patient education and counseling provided upon discharge and reinforced after discharge , sometimes together with improved communication with healthcare professionals , was shown to reduce the risk of adverse drug events and hospital re-admissions in some studies , but not all .
The evidence for an impact of approaches on optimization of continuity of care in medication management remains limited .