Evidence map›Paper›PMID 40279301›Full record

Trial reportPloS one2025

Impacts of pharmacist-led medication reconciliation on discrepancies and 30-days post-discharge health services utilization in elderly Jordanians.

Eman A Hammad, Farah Khaled, Majed Shafaamri, Bara'ah Amireh, Rasha Arabyat, Rana K Abu-Farha

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Eman A HammadDepartment of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan.ORCID 0000-0003-2059-6473
Farah KhaledDepartment of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan.
Majed ShafaamriDepartment of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan.
Bara'ah AmirehRoyal Medical Services, Queen Rania Pediatric Hospital, Total Parenteral Nutrition Unit, Amman, Jordan.
Rasha ArabyatDepartment of Health Economics and Healthcare Administration, Institute of Public Health, University of Jordan, Amman, Jordan.
Rana K Abu-FarhaClinical Pharmacy and Therapeutics Department, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo assess the impacts of pharmacist-led medication reconciliation (MedRec) on medication discrepancies and post-discharge health services utilization in elderly patients in Jordan. And to identify predictors of post discharge outcomes.

methodNewly admitted patients, aged above 65 years were randomly allocated into either a group receiving pharmacist led MedRec or standard care. Within 24 hours of admission, a clinical pharmacist compiled a list of the Best Possible Medication History (BPMH) using at least two sources of information. The pharmacist compared the BPMHs to the admission charts to identify discrepancies and resolved them accordingly. One month post-discharge, patients were assessed for health services use, namely hospital readmissions, emergency department (ED) visits, and adverse drug events (ADEs). Logistic regressions used to investigate predictors of post discharge outcomes.

resultsA total of 128 patients with 151 medication discrepancies were included: 82 (54.3%) discrepancies in the intervention group, and 69 (45.7%) in the control group. A total of 52 Pharmacist-led interventions were recommended to physicians, of which 49 (94.2%) were accepted/implemented. At discharge, the majority of unintentional discrepancies were successfully resolved (p < 0.001). At 30 days post-discharge, patients who were readmitted to the hospital and visited the ED were significantly from the control group. There was no significant difference with respect to experiencing ADEs among the study groups. Patients who received pharmacist-led MedRec had almost 70% lower likelihood of hospital readmission and ED visits. Discrepancies at discharge was associated with higher odds of hospital readmissions.

conclusionPharmacist-led MedRec services improved continuity of care for elderly patients. Implementing a structured reconciliation process successfully resolved discrepancies and reduced hospital readmissions as well as ED visits at 30-days post-discharge. This outlines potentials for healthcare cost savings. Future studies are recommended to explore long-term benefits, cost-effectiveness, and integrating pharmacist-led MedRec into standard discharge planning.

Indexed as

Medication ReconciliationPatient DischargePharmacistsAgedAged, 80 and overEmergency Service, HospitalFemaleHumansJordanMalePatient Readmission

Identifiers

PMID40279301
PMCPMC12027055

What Socratic holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.