International Journal of Clinical Pharmacy

, Volume 40, Issue 5, pp 1189–1198 | Cite as

A dual intervention in geriatric patients to prevent drug-related problems and improve discharge management

  • Johanna Freyer
  • Lysann Kasprick
  • Ralf Sultzer
  • Susanne Schiek
  • Thilo BertscheEmail author
Research Article


Background Drug-related problems (DRPs) endanger geriatric patients’ safety. Especially a follow-up treatment with increased number of care transitions is a critical time for patients. Objective This study aimed at optimising medication therapy and the transfer of medication-related information to ambulatory care in geriatric rehabilitation patients. Setting German geriatric rehabilitation centre (GRC). Method A prospective, controlled intervention study was performed. Patients in the control group (CG) received standard care, those in the intervention group (IG) an additional dual pharmaceutical intervention: (i) medication review to optimise in-hospital medication and (ii) improvement of discharge letters for optimising transfer of medication-related information. Main outcome measure (i) Number of patients with at least one DRP at discharge and (ii) predefined quality criteria for the discharge letters. Results 150 patients were enrolled in CG and 163 in IG. (i) At discharge, 126 (84%) patients in the CG were affected by at least one DRP. In the IG, the number of affected patients decreased to 64 (39%, P < 0.05). (ii) In comparison to discharge letters in the CG, predefined quality criteria were improved in the IG. Following differences were measured (CG vs. IG, each P < 0.05): active ingredient indicated (60 vs. 99%), brand name indicated (60 vs. 96%), explanation of medication changes (47 vs. 68%), visualisation of explanations next to the discharge medication (26 vs. 91%) and recommended therapy duration for short-term medications (49 vs. 84%). Conclusion DRPs and incomplete discharge letters affected many patients. The dual intervention improved in-hospital medication therapy and optimised the transfer of medication-related information.


Aged Clinical Pharmacist Drug-related problem Geriatric Rehabilitation Centre Germany Medication Review Patient Discharge Transitional Care 



We would like to thank all participating physicians and patients being involved in this study.


This study was financially supported by the HELIOS Kliniken GmbH (grant-ID: 003038). The source had no influence on the content and data interpretation of this study.

Conflicts of Interest

All authors declare that they have no conflict of interest concerning this paper.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Johanna Freyer
    • 1
  • Lysann Kasprick
    • 2
  • Ralf Sultzer
    • 2
    • 3
  • Susanne Schiek
    • 1
  • Thilo Bertsche
    • 1
    Email author
  1. 1.Drug Safety Center, University Hospital of Leipzig and Leipzig University and Department of Clinical PharmacyLeipzig UniversityLeipzigGermany
  2. 2.Geriatric Network (GeriNet) LeipzigLeipzigGermany
  3. 3.Sana Geriatric Centre Zwenkau (former: HELIOS Geriatric Centre Zwenkau)ZwenkauGermany

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