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STEPHEN M. SETTER, PHARM.D., D.V.M., CGP, CDE, FASCP, is Associate Professor, Department of Pharmacotherapy, College of Pharmacy; CYNTHIA F. CORBETT, PH.D., RN, is Associate Professor, College of Nursing; JOSHUA J. NEUMILLER, PHARM.D., CDE, CGP, FASCP, is Assistant Professor, Department of Pharmacotherapy, College of Pharmacy; BRIAN J. GATES, PHARM.D., is Clinical Associate Professor, Department of Pharmacotherapy, College of Pharmacy; DAVID A. SCLAR, B.PHARM., PH.D., is Boeing Distinguished Professor of Health Policy and Administration, and Director, Pharmacoeconomics and Pharmacoepidemiology Research Unit, Department of Health Policy and Administration; TRAVIS SONNETT, PHARM.D., is Clinical Assistant Professor, Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane.

Address correspondence to Dr. Setter at the Department of Pharmacotherapy, College of Pharmacy, Washington State University, 5125 North Market Street, Spokane, WA 99217 (ssetter{at}smhca.org).

Purpose. The effectiveness of a collaborative pharmacist–nurse intervention on resolving detected medication discrepancies as patients transitioned from hospital to home health care was evaluated. Methods. Patients age 50 years or older who were transitioning from hospital to home health care with qualifying diagnoses were eligible for study inclusion. Patients were assigned to a control or intervention group based on the geographic location of the patients’ home. For the intervention group, the study coordinator initiated consultation with the nurse case manager to facilitate discrepancy resolution. Patients in the control group received usual care after the initial home visit by the study coordinator. Rehospitalization rates and the number of planned and unplanned physician visits were analyzed. Descriptive statistics were used to characterize and contrast patients in each study group. Equivalency testing was conducted to evaluate group comparability for demographic and health status variables and the use of health care services. Results. A total of 490 medication discrepancies were identified. The discrepancy resolution rates in the intervention and control groups were 67.0% and 54.6%, respectively. Assignment to the intervention group was associated with enhanced medication discrepancy resolution (r = 0.539, p = 0.001). There was a trend toward more planned and unplanned physician visits, and a trend toward a greater number of rehospitalization days. Conclusion. A pharmacist–nurse collaboration designed to identify and resolve medication-related discrepancies in patients transitioning from the hospital to home health care led to significant improvement in medication discrepancy resolution. Index terms: Drugs, adverse reactions; Errors, medication; Health care; Hospitals; Nurses; Patient care; Pharmacists