Transition from Hospital to Home: Can Pharmacists’ Interventions Improve Patients’ Outcomes?
Bibliographic record
Abstract
1found that more than 1 in 5 patients discharged from a general medicine service to home experienced an adverse event, and 72% of the adverse events were related to medica tions. Other authors have reported similar findings, with adverse drug events being common in the month following discharge. 2 In a recent small Canadian study, 3 77% of patients discharged from an acute care institution had at least one drug therapy problem in the 2 weeks following discharge, linked to gaps in the transfer of medication-related information. The authors of many of these studies have suggested that close follow-up in the first few weeks after discharge could prevent many of these adverse drug events, improving patient outcomes and minimizing the expenditure of health care resources. Intuitively, it seems that patients would benefit from care provided by a pharmacist during this transition period. In this issue of the Journal, Flanagan and others 4 describe a clinical program in which elderly patients received medication management services in their homes after discharge from hospital, with savings in health service resources during the following year. Although many studies have reported positive outcomes from provision of pharmacists’ services in the home, many more have indicated otherwise, including randomized controlled trials 5 that have demonstrated an increase in hospital admissions among patients receiving such in-home care. One suggestion has been that these results may be due to better awareness of health concerns, leading to use of more resources, 5 but other issues need to be considered. Factors that may account for the conflicting evidence in this area include the type of intervention studied, the pharmacist’s qualifications, and whether or not the care was provided within a collaborative context. Studies evaluating clinical pharmacy services in the home have been published over a period of more than 3 decades. During this time, the role of the pharmacist has changed considerably. Earlier literature reflected the pharmacist’s role as a consultant within established home care agencies. The pharmacist did not often work directly with the patient but
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.038 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".