TABLE 1.

Pharmacist Intervention Model, with 3 Types of Clustering: Intervention Target, Intervention Nature, and Stage

Intervention Number	Intervention Category	Clarification	Target	Nature	Stage
1	Admission reconciliation	All activities that led to assembling an accurate medication list, including a check for appropriateness of prescribing and documentation of changes.	HCP	A	OA
2	Patient counseling on admission	Actively incorporating the patient as a source (or recipient) of information. Patient counseling was not restricted to a certain stage, therefore, this intervention was split to allow assignment to all stages (intervention numbers 1, 5, and 7).	Pt	P	OA
3	Pharmacist is part of medical team	Pharmacist was an active member of the medical team, e.g., by participating in ward rounds.	HCP	P	DA
4	Medication review	According to Hatah et al.,64 medication review can be classified into 4 levels of comprehensiveness: (1) prescription review, (2) adherence support review (with patient present), (3) clinical review, and (4) clinical review with prescribing. The latter 2 are conducted in close collaboration with physicians. All levels were clustered in the PIM, but to prevent overclassification of lower levels, the accompanying number is indicated in the results.	HCP	P	DA
5	Patient counseling during admission	See intervention 2.	Pt	P	DA
6	Discharge reconciliation	See intervention 1.	HCP	A	AD
7	Patient counseling at discharge	See intervention 2.	Pt	P	AD
8	Supplying patient with discharge letter	Providing the patient with a copy of the discharge letter to facilitate medication management postdischarge.	Pt	A	AD
9	Transmission to next HCP	Transmission of an updated and verified medication list to next health care provider.	HCP	A	AD
10	Patient-centered follow-up	Postdischarge follow-up classification was based on intervention target. The subdivision in house calls (H), clinic visits (C), and telephone calls (T) is indicated in the results. Patient-centered follow-up comprises adherence counseling, for example.	Pt	P	PD
11	HCP-centered follow-up	See intervention 10. HCP-centered follow-up consists of reporting drug-related problems to general practitioner, for example.	HCP	P	PD
12	Extra postdischarge follow-up	Additional postdischarge follow-up to review progress and/or reinforce initial advice.	Pt	P	PD
13a	Tailored interventions	Interventions were tailored to individual patient’s needs (e.g., cognition or low-literacy skills).	Pt	P	SI
14a	Provision of adherence aids	Supplying a pill box or a daily reminder routine, for example.	Pt	A	SI
15a	Dispensing or logistics aids	Disposing of out-of-use or out-of-date medication, for example.	Pt	A	SI

^a Interventions 13-15 were not bound to a certain stage and were therefore scored as stage independent.

A = administrative; AD = at discharge; DA = during admission; HCP = health care provider; OA = on admission; P = professional; PD = postdischarge; PIM = pharmacist intervention model; Pt = patient; SI = stage independent.