explanation for these unexpected figures since one
would expect that a higher quality in prescribed drugs,
an increased awareness of drugs in patients and an
improved communication of drug treatment between
hospital and primary care would be favourable. One
may speculate, however, that the pharmacist intervention
resulted in patients being either taken off medication
that they would benefit from or that doses were
reduced below the clinically optimal level in an effort to
reduce harmful side effects or drug interactions.
However, few changes in prescribed drugs were made
due to the first part of the intervention, that is, the
pharmacist recommendations on modifications in
drug therapy,13 and we deem these unlikely to have
had a major impact on patient health. Probably, the
observed difference in deaths occurred by chance, but
irrespective of the causality of the deaths, these negatively
affected the number of QALYs gained in the
intervention group.