Emergency Department Reconsultations After a Secondary Prevention Bundle for Medication-Related Problems: A...

Area of Science:

• Pharmacology and Pharmacy Practice
• Geriatric Medicine
• Emergency Medicine

Background:

• Drug-related problems (DRPs) are a significant, preventable cause of emergency department (ED) visits.
• A pharmacist-led intervention, including medication optimization and adherence counseling, was integrated into ED practice in December 2022.
• This intervention aimed to reduce reconsultations and improve patient outcomes post-discharge.

Purpose of the Study:

• To quantify 30- and 90-day reconsultations after discharge following a pharmacist-led intervention.
• To identify factors associated with drug-related problem (DRP)-related revisits to the emergency department (ED).

Main Methods:

• Retrospective cohort study of adult patients (≥18 years) attending a tertiary ED in Barcelona, Spain.
• Included index DRP visits between December 2022 and June 2024, all receiving the pharmacist intervention bundle.
• Data extracted from the Catalan Shared Health Record; revisits classified by an independent committee; multivariable logistic regression used to assess predictors of 30-day DRP revisits.

Main Results:

• Overall 30-day ED reconsultations were 9.6% (120/1247), with 30.8% (37/120) attributed to DRPs.
• DRP-related revisits were predominantly recurrences (81% at 30 days, 80% at 90 days).
• Patients aged ≥80 years showed a significantly lower risk of 30-day DRP revisits (OR 0.32; 95% CI 0.13-0.79).

Conclusions:

• The pharmacist-led intervention resulted in 9.6% 30-day ED reconsultations, with approximately one-third linked to DRPs, mainly recurrences of gastrointestinal bleeding and seizures.
• Findings suggest potential benefits for older adults (≥80 years), possibly due to specialized geriatric care pathways.
• Targeted post-discharge monitoring for high-recurrence DRPs is recommended to further reduce avoidable ED use, with future studies in quasi-experimental or randomized designs.