Patient Safety
Jen Hand
Findings of a study published in the June 2025 issue of JAMA Internal Medicine revealed that a pharmacist-led intervention in the emergency department (ED) significantly reduced hospitalizations and ED visits related to the same medication-related event at 6 months compared with usual care.
Medication-related events (MREs) are defined in the article as “any harm related to medication management and can result from appropriate, unsuitable, or a lack of care, including nonadherence.” MREs are a widespread public health issue, leading to global initiatives calling to reduce medication-related harms.
Repeated MREs are also troubling, with prior research suggesting an over 30% recurrence of MREs, the vast majority of which are avoidable. Patients with a history of a previous MRE are at risk of it happening again and often the recurrences are related to the same drug class as the first time.
The researchers realized the pivotal role pharmacists can play in detecting, documenting, and preventing MREs and noted promising studies with pharmacist-led interventions such as transitional care programs and medication reconciliation. However, they also cited the mixed results in randomized clinical trials and limited success of electronic tools for deprescribing or medication reconciliation.
“Innovative strategies are needed to ensure that prescribers and dispensers consider previously diagnosed MREs,” they wrote.
A related Editor’s Note in the same JAMA Internal Medicine issue recognized the novel approach the URGEIM trial took.
“Uniquely, the trial focused on secondary prevention—targeting patients who presented to the emergency department for medication-related events—predominantly adverse drug events with appropriate use, but also adverse drug events related to medication nonadherence,” wrote Timothy S. Anderson, MD.
Study design and results
The URGEIM trial was conducted at a hospital in France over a 3-year period ending in January 2022, and data were analyzed through March 2024. The parallel-group, open-label trial included adult patients admitted to the ED with an MRE detected. Eligible adult patients were randomized by the ED pharmacist and allocated to the control group (usual care) or a pharmacist-led transition of care program.
The 330 eventual study participants were 56.7% female, the median age was 71, and the median home medications count was six. The transition of care group (167 patients) and the control group (163 patients) had similar baseline characteristics, according to researchers.
All patients were subject to a pharmaceutical and medical interview in tandem, and the best possible medication history was documented by the ED pharmacist as usual care. The researchers estimated the mean pharmacist time required for MRE detection at 60 minutes per patient.
For the transition of care group, in addition to the letter of discharge (also part of usual care), the ED pharmacist set up a 72-hour post-discharge alert process. That group had ED pharmacists follow up with a post-discharge call to the patient’s physician and community pharmacist as well as a letter notifying them about the type of MRE, suspected medication, and management recommendations such as therapeutic modification, referral to specialists, and names and contact information of the ED medical team.
Results of the study found that at 6 months the transition of care group had a 19% reduction in the primary outcome of ED visits for the same MRE. There were also decreases in all-cause ED visits and hospitalizations for the same MREs, as well as lower mean medical costs in the transition of care group.
Clinical implications
The researchers observed limitations, including the possibility of the effectiveness of the intervention varying across health systems depending on the availability of integrated pharmacy services and that findings may require validation through multicenter trials. However, they also acknowledged the value of their multidisciplinary approach. Structuring the process of MRE detection and “early communication with primary care teams…facilitated better continuity of care, improving patient outcomes and reducing hospital health care utilization,” wrote the research team.
Anderson noted that further evaluation of the feasibility and generalizability of a 60-minute (estimated) intervention would be necessary, but “despite the caveats, the implications and cost-savings of an effective secondary prevention approach as highlighted in this study to reduce medication-related harms may be vast,” Anderson wrote. ■