Coordinated pharmaceutical Transitional Care interventions involving at-risk patients from hospital admission: a pre-post study
Transitions of care are critical stages during which medication‑related problems are likely to occur. Suboptimal continuity of care is recognized as one of the causes of potentially avoidable hospital readmissions. A robust strategy to ensure medication safety during care transitions helps reduce these readmissions and addresses one of the three priorities established by the WHO in 2019 as part of its “Global Patient Safety Challenge.”
Studies show that involving pharmacists during transitions of care improves patient safety. However, in Switzerland, such practices remain limited, are often conducted in silos, and involve community pharmacies only minimally.
Aim
The aim of this project is to implement a model combining:
- Medication reconciliation at hospital admission and discharge by the hospital pharmacist, using the patient and their community pharmacy as sources of information
- Systematic transmission of medication‑related information between hospital and ambulatory settings
- A pharmaceutical consultation in a community pharmacy after hospital discharge to improve the patient’s knowledge of their treatments
Expected outcomes
Primary objective: reduction of iatrogenic risk through:
- Correction of unintentional discrepancies at hospital admission and discharge
- Improved patient knowledge of their treatments and their management
- Better communication between hospital and community healthcare professionals
Method
The study takes place in two phases: a control phase, and an “intervention” phase.
For each phase, 130 patients are included.
The control phase took place between August 2024 and February 2026. The intervention phase begins in June 2026.
Patient inclusion is carried out by the research team upon admission to the internal medicine department of the CHUV. The study is offered to all patients who meet the following criteria:
- Preserved decision‑making capacity and informed consent
- Autonomous in managing their medication (without healthcare professionals such as a pharmacy or home‑care services)
- Presence of at least one of the following:
- Polypharmacy (≥ 5 medications per day)
- A high‑risk medication
- A previous hospitalization at CHUV within the last six months and at least one ongoing outpatient medication
- For the Intervention Group: the patient’s community pharmacy is located in the canton of Vaud and has agreed to participate in the study
The intervention process is detailled in the following flowchart: https://canva.link/processus-phasemed