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Table 2 Fidelity of pharmacists’ interventions

From: Effect of a care transition intervention by pharmacists: an RCT

  Enhanced Minimal P-values
  n = 311 n = 312  
Admission medication reconciliation 311 (100%) 312 (100%)  
Community pharmacy contacted 300 (96.5%) 305(97.8%) 0.34
Discharge counseling completed 235 (75.6%) 235 (75.3%) 0.94
Wallet card completed 309 (99.4%) 308 (98.7%) 0.41
Medication issues identified in hospital 275 (88.4%) 249 (79.8%) 0.003
Post-discharge phone call completed 301 (96.8%) 4 (1.3%)*  
Discharge care plan faxed to community physician 267 (85.9%) 1 (0.3%)*  
Discharge care plan faxed to community pharmacist 246 (79.1%) 1 (0.3%)*  
Discharge care plan included medication recommendations to community physician 207 (66.6%) NA  
Discharge care plan medication issues identified by pharmacists† To Hospital & Community Physicians To Hospital Physicians  
  Mean (±SD) 6.6 (±6.8) 3.2 (±4.0)  
  Total number of issues identified 2063 1012  
  Dosing or administration 260 131  
  Indication 754 363  
  Efficacy 319 101  
  Cost 103 38  
  Risk to patient 627 379  
Discharge care plan recommendations made to physicians† To Hospital & Community Physicians To Hospital Physicians  
  Mean (±SD) 7.1 (±6.6) 3.5 (±3.8)  
  Total number of recommendations 2220 1077  
  Discontinue medications 377 195  
  Add medications 566 256  
  Change medications 361 151  
  Disease monitoring 280 56  
  Follow-up patient 262 134  
  Patient education 283 239  
  Adherence education 91 46  
Time pharmacist spent on each patient (minutes) 210.0 (±93.0) 118.5 (±58.6) <.0001
  1. *Inadvertent crossover since care plans should not have been sent according to randomization.
  2. †Many but not all medication issues and recommendations were repeated to the community physicians, accounting for almost twice the numbers in the enhanced group.