The transition from hospital to home can be a time of increased risk for older adults. Many leave the hospital with complex medical regimens that involve multiple or high-risk medications, which can lead to adverse drug events and unplanned visits to the emergency department or hospital readmissions.

Jeffrey Schnipper, MD, MPH

A study co-led by Jeffrey Schnipper, MD, MPH, a physician-investigator at Mass General Brigham, evaluated whether a comprehensive pharmacist-led, transitions-of-care program could reduce unplanned hospital and emergency department use within 30 days of discharge.

The large pragmatic randomized clinical trial included 6,478 hospitalizations among adults aged 55 and older at two urban academic medical centers on ten or more home medications or three or more high-risk medications.

Participants were assigned to either usual care or a pharmacist-led discharge intervention that included medication review, patient education, discharge medication reconciliation, coordination with outpatient clinicians and pharmacies, and post-discharge follow-up calls.

Patients in both arms of the study received a “best possible medication history” and admission medication reconciliation. The primary outcome was unplanned hospital or emergency department use within 30 days of discharge.

Overall, the intervention did not significantly reduce post-discharge health care utilization compared with usual care. Both groups already benefited from strong baseline medication reconciliation practices, which may have limited the added impact of the intervention.

However, subgroup analyses showed a meaningful benefit for patients with low medication adherence and limited medication literacy. In this group, pharmacist-led discharge care was associated with a significant reduction in unplanned healthcare use, from 29% to 18%.

These findings suggest that transitional care interventions may be most effective when targeted to patients who face the greatest challenges in understanding and managing their medications.

Published in JAMA Network Open, March 2026 | Read the paper: “Pharmacist-Led Discharge Care to Reduce Postdischarge Health Care Utilization”
Summary reviewed by: Jeffrey Schnipper, MD, MPH, senior author