***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: Background Adherence to evidence based medicines in patients who have experienced a myocardial infa rct ion remains low . Individual ’s beliefs towards their medicines are a strong predictor of adherence and may influence other factors that impact on adherence . Objective To investigate if community pharmacists discussing patients ’ beliefs about their medicines improved medication adherence at 12 months post myocardial infa rct ion . Setting This study included 200 patients discharged from a public teaching hospital in Queensl and , Australia , following a myocardial infa rct ion . Patients were r and omised into intervention ( n = 100 ) and control groups ( n = 100 ) and followed for 12 months . Method All patients were interviewed between 5 to 6 weeks , at 6 and 12 months post discharge by the research er using the repertory grid technique . This technique was used to elicit the patient ’s individualised beliefs about their medicines for their myocardial infa rct ion . In the intervention group , patients ’ beliefs about their medicines were communicated by the research er to their community pharmacist . The pharmacist used this information to tailor their discussion with the patient about their medication beliefs at design ated time points ( 3 and 6 months post discharge ) . The control group was provided with usual care . Main outcome measure The difference in non-adherence measured using a medication possession ratio between the intervention and control groups at 12 months post myocardial infa rct ion . Results There were 137 patients remaining in the study ( intervention group n = 72 , control group n = 65 ) at 12 months . In the intervention group 29 % ( n = 20 ) of patients were non-adherent compared to 25 % ( n = 16 ) of patients in control group . Conclusion Discussing patients ’ beliefs about their medicines for their myocardial infa rct ion did not improve medication adherence . Further research on patients beliefs should focus on targeting non-adherent patients whose reasons for their non-adherence is driven by their medication beliefs 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 : Warfarin remains a high-risk drug for adverse events , especially following discharge from the hospital . New approaches are needed to minimize the potential for adverse outcomes during this period . Objective : To evaluate the clinical outcomes of a collaborative , home-based postdischarge warfarin management service adapted from the Australian Home Medicines Review ( HMR ) program . Methods : In a prospect i ve , nonr and omized controlled cohort study , patients discharged from the hospital and newly initiated on or continuing warfarin therapy  received either usual care ( UC ) or a postdischarge service ( PDS )  of 2 or 3 home visits by a trained , HMR-accredited pharmacist in their first 8 to 10 days postdischarge . The PDS involved point-of-care international normalized ratio ( INR ) monitoring , warfarin education , and an HMR , in collaboration with the patient 's general practitioner and community pharmacist . The primary outcome measure was the combined incidence of major and minor hemorrhagic events in the 90 days postdischarge . Secondary outcome measures included the incidences of thrombotic events , combined hemorrhagic and thombotic events , unplanned and warfarin-related hospital readmissions , death , INR control , and persistence with therapy al 8 and 90 days postdischarge . Results : The PDS ( n = 129 ) was associated with statistically significantly decreased rates of combined major and minor hemorrhagic events to day 90 ( 5.3 % vs 14.7 % ; p = 0.03 ) and day 8 ( 0.9 % vs 7.2 % ; p = 0.01 ) compared with UC ( n = 139 ) . The rate of combined hemorrhagic and thrombotic events to day 90 also decreased ( 6.4 % vs 19.0 % ; p = 0.008 ) and persistence with warfarin therapy improved ( 95.4 % vs 83.6 % ; p = 0.004 ) . No significant differences in readmission and death rates or INR control were demonstrated . Conclusions : This study demonstrated the ability of appropriately trained accredited pharmacists working within the Australian HMR framework to reduce adverse events and improve persistence In patients taking warfarin following hospital discharge . Widespread implementation of such a service has the potential to enhance medication safety along the continuum of care . KEY WORDS : adverse drug events , community pharmacy services , international normalized ratio , patient discharge , warfarin Objective To test whether a drug review and symptom self management and lifestyle advice intervention by community pharmacists could reduce hospital admissions or mortality in heart failure patients . Design R and omised controlled trial . Setting Home based intervention in heart failure patients . Participants 293 patients diagnosed with heart failure were included ( 149 intervention , 144 control ) after an emergency admission . Intervention Two home visits by one of 17 community pharmacists within two and eight weeks of discharge . Pharmacists review ed drugs and gave symptom self management and lifestyle advice . Controls received usual care . Main outcome measures The primary outcome was total hospital readmissions at six months . Secondary outcomes included mortality and quality of life ( Minnesota living with heart failure question naire and EQ-5D ) . Results Primary outcome data were available for 291 participants ( 99 % ) . 136 ( 91 % ) intervention patients received one or two visits . 134 admissions occurred in the intervention group compared with 112 in the control group ( rate ratio=1.15 , 95 % confidence interval 0.89 to 1.48 ; P=0.28 , Poisson model ) . 30 intervention patients died compared with 24 controls ( hazard ratio=1.18 , 0.69 to 2.03 ; P=0.54 ) . Although EQ-5D scores favoured the intervention group , Minnesota living with heart failure question naire scores favoured controls ; neither difference was statistically significant . Conclusion This community pharmacist intervention did not lead to reductions in hospital admissions in contrast to those found in trials of specialist nurse led interventions in heart failure . Given that heart failure accounts for 5 % of hospital admissions , these results present a problem for policy makers who are faced with a shortage of specialist provision and have hoped that skilled community pharmacists could produce the same benefits . Trial registration number IS RCT N59427925 Background : Medication regimens are constantly modified and up date d during a patient 's hospitalization . These modifications and those made after discharge might increase the risk for nonadherence , polypharmacy , and poor outcomes among elderly patients . Objectives : To investigate the extent of in-hospital modification of medication regimens of elderly patients and its relationship to medication adherence as well as one-month postdischarge drug regimen modifications and to examine the relationship of the modifications , adherence , and polypharmacy to mortality and readmissions 3 months postdischarge . Methods : Clinical and demographic data , postdischarge medication modifications , and adherence were prospect ively obtained in 212 elderly patients . Inhospital drug regimen modifications were retrospectively recorded . Results : The average ± SD in-hospital medication regimen modification rate was 49.8 % ± 28.4 . No modifications were found in 9.7 % of the patients . Using demographic and clinical parameters , we performed regression analysis and found that patients who were admitted with polypharmacy , discharged home , and cognitively normal experienced fewer medication modifications ( p conclusions : Hospitalization of elderly patients is characterized by extensive medication regimen modifications , which are directly correlated with postdischarge modifications and may indicate an increased risk of mortality Purpose : Medication errors related to hospital discharge result in rehospitalization and emergency department ( ED ) visits , yet no systematic approach has been implemented nationally to decrease these medication errors . Pharmacist involvement during postdischarge transitions of care may be an important strategy to prevent and correct medication discrepancies and reduce costly rehospitalization and ED visits . Methods : This prospect i ve , r and omized , open-label , pilot study evaluated the effect of a pharmacy clinic visit focused on medication reconciliation and patient education after hospital discharge on the incidence of rehospitalization and ED visits and the resolution of medication discrepancies . Results : Of the 61 subjects included in the study , 33 ( 54 % ) had medication discrepancies identified at discharge . Fifty percent of medication discrepancies were resolved in subjects r and omized to the pharmacist intervention arm compared with 9.5 % in the usual care arm ( P = .015 ) . Patients r and omized to the intervention arm had significantly lower rates of the primary composite outcome of 30-day rehospitalization and ED visits compared with the usual care arm ( 0 % vs 40.5 % , P < .001 ) . Conclusion : A pharmacist-driven intervention focused on patient education and medication reconciliation after discharge improved medication use and reduced health care re source utilization in this pilot study BACKGROUND Poorly executed transfers of older patients from hospitals to long-term care facilities carry the risk of fragmentation of care , poor clinical outcomes , inappropriate use of emergency department services , and hospital readmission . OBJECTIVE This study was conducted to assess the impact of adding a pharmacist transition coordinator on evidence -based medication management and health outcomes in older adults undergoing first-time transfer from a hospital to a long-term care facility . METHODS This r and omized , single-blind , controlled trial enrolled hospitalized older adults awaiting transfer to a long-term residential care facility for the first time . Patients were r and omized either to receive the services of the pharmacist transition coordinator ( intervention group ) or to undergo the usual hospital discharge process ( control group ) . The intervention included medication-management transfer summaries from hospitals , timely coordinated medication review s by accredited community pharmacists , and case conferences with physicians and pharmacists . The primary outcome was the quality of prescribing , measured using the Medication Appropriateness Index ( MAI ) . Secondary outcomes were emergency department visits , hospital readmissions , adverse drug events , falls , worsening mobility , worsening behaviors , increased confusion , and worsening pain . RESULTS One hundred ten older adults ( 67 women , 43 men ; mean [ SD ] age , 82.7 [ 6.4 ] years ) were recruited from 3 metropolitan hospitals and assigned to 85 metropolitan long-term care facilities . Fifty-six patients were r and omized to the intervention group and 54 to the control group ; 44 patients in each group were evaluable at 8-week follow-up . There were no significant differences in baseline characteristics between treatment groups , with the exception of the number of medications discontinued during hospitalization : a mean of 1.1 more drugs was discontinued in the control group compared with the intervention group ( P = 0.011 ) . The majority of patients ( 35 [ 62.5 % ] in the intervention group , 41 [ 76.0 % ] in the control group ) changed physicians as part of the transition to a long-term care facility . At 8-week follow-up , there was no change in MAI from baseline in the intervention group , whereas it had worsened in the control group ( mean [ 95 % CI ] , 2.5 [ 1.4 - 3.7 ] vs 6.5 [ 3.9 - 9.1 ] , respectively ; P = 0.007 ) . Patients who received the intervention and were alive at follow-up exhibited a significant protective effect of the intervention against worsening pain ( relative risk ratio [ 95 % CI ] , 0.55 [ 0.32 - 0.94 ] ; P = 0.023 ) and hospital usage ( i.e. , the combination of emergency department visits and hospital readmissions ) ( 0.38 [ 0.15 - 0.99 ] ; P = 0.035 ) , but did not differ from control patients in terms of adverse drug events ( 1.05 [ 0.66 - 1.68 ] ) , falls ( 1.19 [ 0.71 - 1.99 
    Output:
    
Other patient outcomes such as medication adherence and clinical control were not unanimously positively or negatively influenced via the inclusion of community pharmacy in a transfer of care post-discharge intervention .
There is evidence that interventions including a community pharmacist can improve drug related problems after discharge .
However , impact on other outcomes is not consistent .
Also applying more stringent controls and closer adherence to protocol s in both intervention and control groups would allow clearer correlations to be made between the intervention and the outcomes