An interventional study of Support of the hospital pharmacist for the medication management at hospital discharge in Polypharmacy, sponsored by Pharmacie des Hopitaux de l'Est Lemanique. Terminated at 1 site in Switzerland. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-09-09.
Sponsored by Pharmacie des Hopitaux de l'Est Lemanique · Not applicable, Interventional, and Supportive care
The aim of this study is to evaluate the impact of an enhanced collaboration between a hospital pharmacist and a community pharmacist during hospital discharge. For patients taking multiple medications, hospitalization often involves numerous changes to their treatment regimen. For community pharmacies, discharge prescriptions are often complex, and they sometimes lack the information that pharmacists need to deliver the treatment as safely as possible. As a result, there is a risk of medication errors, and a risk for patients. We aim to evaluate the benefits of this collaboration for adult patients admitted to the internal medicine ward of a regional hospital who are taking seven or more drugs and are being discharged to home.
The main question it aims to answer is : Does the enhanced collaboration reduce the number of drug-related problems encountered by community pharmacists with discharge prescriptions ? Researchers will compare patients when a hospital pharmacist is involved during the discharge process and when he or she is not involved, which corresponds to normal care.
The hospital pharmacist will not perform the intervention directly on the patient, but only with the community pharmacy. Once they agree to participate in the study, patients will only have to go to their usual community pharmacy after discharge and accept that the hospital transmits medical information to their usual pharmacy.
Pharmacie des Hopitaux de l'Est Lemanique is the lead sponsor of 2 studies on the registry; 1 is open to participants now.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Participants in the control arm will benefit from the usual standard of care currently provided in routine clinical practice. Physicians performs medication reconciliation on their own and hand-out the prescription to the patient the day of discharge. The patient then goes to the pharmacy for a classical drug dispensation.
Participants in the intervention group will benefit from the hospital pharmacist's support to optimize medication management and ensure a safe and effective discharge process.
Other: Support of the hospital pharmacist for the medication management at hospital discharge
1\) The hospital pharmacist calls the community pharmacy the day before discharge to order unusual or specific medications 2) The day of discharge, the hospital pharmacist performs a medication reconciliation in collaboration with the hospital physician 3) Once completed, the discharge prescription is sent to the community pharmacy before the patient is discharged. 4) The hospital pharmacist calls the community pharmacy to provide additional information about the patient and the prescription and to answer any questions. Additional information will help the community pharmacist to understand the prescription : administrative data, clinical data, medication-related information, patient follow-up and patient concerns.
Number of drug-related problems on the hospital discharge prescription
Community pharmacists will assess the number of drug-related problems (DRP) on the discharge that they faced when preparing the discharge medication. They will have to use the PharmDISC system, which is a validated tool for referencing drug-related problems faced in the community which was adapted from the drug-related problems classification system of the Pharmaceutical Care Network Europe (PCNE). Community pharmacists will also document the intervention performed for each DRP, and the resolution (yes/no) of the DRP.
Time frame: 7 days after hospital discharge
Patient's satisfaction
Patients' satisfaction related to their visit at the pharmacy after hospital discharge will be assessed using a questionnaire. Patients will be contacted via email or telephone
Time frame: 7 days after hospital discharge
Community pharmacists' satisfaction
The satisfaction of community pharmacists with the service provided by the hospital pharmacist at patient discharge will be evaluated
Time frame: Through study completion, approximately 6 months
30 day readmission rate
Number of participants with hospital emergency department visits and hospital readmission in the same hospital within 30 days of discharge
Time frame: 30 days after hospital discharge
Plan to share: Yes — Data to be shared includes demographic and study outcomes, with a data summary Data will be anonymized and shared in a secure format (CSV)
Supporting information: Study protocol, Sap, Icf, Csr, Analytic code
This study is terminated, as verified in Sep 2026. You cannot join it, but the record below documents what was studied.
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Pharmacie des Hopitaux de l'Est Lemanique