Role of pharmacist counseling in preventing adverse drug events after hospitalization.

Background: Hospitalization and subsequent discharge home often involve discontinuity of care, multiple changes in medication regimens, and inadequate patient education, which can lead to adverse drug events (ADEs) and avoidable health care utilization. Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and follow-up by pharmacists on preventable ADEs.

Methods: We conducted a randomized trial of 178 patients being discharged home from the general medicine service at a large teaching hospital.