Abstract
Transitions of care represent vulnerable periods for older adults receiving polypharmacy, often precipitating preventable adverse drug events (ADEs) and hospital readmissions. This quasi-experimental study evaluated the clinical effectiveness of a telemedicine-based, clinical pharmacist-led medication reconciliation intervention conducted within 48 to 72 hours post-discharge in geriatric patients. A cohort of 412 hospitalized patients aged 65 years and older taking five or more daily medications was enrolled into either a telemedicine intervention group (n = 208) or a usual care control group (n = 204). The primary outcome was the incidence of clinically adjudicated ADEs within 30 days post-discharge. Secondary outcomes included unintentional medication discrepancies identified and resolved, 30-day all-cause hospital readmissions, and emergency department visits. The intervention group experienced a significantly lower rate of 30-day ADEs compared with usual care (11.1% vs. 24.5%; adjusted odds ratio [aOR] = 0.38, 95% confidence interval [CI]: 0.22–0.66; p < 0.001). Pharmacists identified and reconciled a mean of 2.3 ± 1.1 medication discrepancies per patient in the telemedicine group, primarily involving drug omissions, incorrect dosages, and therapeutic duplications. Furthermore, 30-day all-cause readmission rates were significantly reduced in the intervention cohort (12.0% vs. 19.6%; aOR = 0.54, 95% CI: 0.31–0.93; p = 0.026). Timely telemedicine-based pharmacist reconciliation effectively bridges post-discharge care transitions, substantially mitigating medication-related harm in vulnerable geriatric populations.
