Table 3.

PHARM-DC Intervention Components

Admission medication reconciliation

Medication regimen review/optimization

Actions to improve adherence

Side effect management

Drug level monitoring

Discharge Medication Reconciliation

Patient/caregiver education: indications, directions, reasons for changes in regimen

Motivational interviewing

Post discharge follow up phone call

Post discharge additional phone call

Medication Access (e.g. problems obtaining medications)

Communication with PCP

Communication with community pharmacy