We conducted a randomized trial of 178 patients
being discharged home from the general medicine
service at a large teaching hospital. Patients in the
intervention group received pharmacist counseling at discharge
and a follow-up telephone call 3 to 5 days later.
Interventions focused on clarifying medication regimens;
reviewing indications, directions, and potential side
effects of medications; screening for barriers to adherence
and early side effects; and providing patient counseling
and/or physician feedback when appropriate. The
primary outcome was rate of preventable ADEs.