Table 5.
Effect of the COACH program on medication reconciliation interventions (n = 365)
| Outcome: drug-related problems | Hospital admission mean/pat (%d) | Hospital discharge mean/pat (%d) | Patient counselling mean/pat (%d) | Total mean/pat (%d) |
|---|---|---|---|---|
| Elimination of discrepanciesa | 1.65 (62.4) | 1.43 (68.2) | 0.82 (49.7) | 3.90 (89.2) |
| Optimisation of pharmacotherapyb | 0.10 (9.7) | 1.76 (75.1) | 0.15 (13.0) | 2.02 (80.4) |
| Optimisation medication handlingc | – | – | 4.15 (97.8) | 4.15 (97.8) |
| Total | 1.75 (64.1) | 3.19 (93.4) | 5.12 (98.9) | 10.07 (100.0) |
a Examples: omission of pre-admission used diabetes drug started at hospital admission, temporarily discontinued anticoagulant restarted at hospital discharge, patient used a different dose of inhalation medication pre-admission
b Examples: a laxative added to opioid use at admission, analgesics or protonpumpinhibitor discontinued at discharge as there was no indication anymore, patient states that sedative is no longer needed
c Examples: questions of patient regarding side effect answered, adherence to medication and helping tools discussed, medication changes explained
d Percent of patients for whom at least one intervention was registered