{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:15:28Z","timestamp":1788974128656,"version":"build-2803163510"},"reference-count":0,"publisher":"Canadian Society of Healthcare-Systems Pharmacy","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can J Hosp Pharm"],"abstract":"<jats:p>Background: Involvement of pharmacists in discharge medication reconciliation (DMR) reduces readmissions when DMR is delivered as part of a medication management bundle. With current staffing and workload, pharmacists are unable to complete DMR for every inpatient. Consequently, it is necessary to prioritize patients for DMR interventions according to clinical need and risk.\nObjectives: To describe how pharmacists prioritize patients for DMR at a tertiary hospital; to identify facilitators of and barriers to pharmacist involvement in DMR; and to compare pharmacists\u2019 patient-priority assessment with scores derived using the Epic risk-of-unplanned-readmission, PRIME, and PADR-EC risk assessment tools.\nMethods: Pharmacists involved in DMR participated in focus groups to explore their DMR practices, including factors considered in patient prioritization, as well as facilitators of and barriers to their involvement in DMR. For patients on their service with an expectation of discharge within 48 hours, pharmacists used a questionnaire to rank DMR priority and indicate their intent to complete DMR. For each patient, the Epic, PRIME, and PADR-EC scores were collected and compared with the pharmacist\u2019s assessment.\nResults: A total of 13 pharmacists participated in 2 focus groups, and 11 of these pharmacists completed the questionnaire (for a total of 110 patients). Twenty-two unique factors and 27 subfactors for patient prioritization were identified. The top 5 factors were complex medication regimen, high-risk medications, medication changes, medication access, and length of stay. Facilitators and barriers were categorized into 6 themes: team dynamics, pharmacist workload, prior pharmacist involvement, process for DMR, discharge planning, and technology. Pharmacists\u2019 assessments appeared to differ from scores obtained with the 3 risk assessment tools.\nConclusions: Pharmacists at the study institution lacked a consistent approach to prioritizing patients for DMR. Next steps will include developing and piloting a standardized process for prioritization.\nKeywords: medication reconciliation, pharmacy service, hospital, pharmacists, risk factors, patient discharge\nR\u00c9SUM\u00c9\nContexte : L\u2019implication des pharmaciens dans le bilan comparatif des m\u00e9dicaments (BCM) au moment du cong\u00e9 r\u00e9duit les r\u00e9admissions lorsqu\u2019il est fourni dans le cadre d\u2019un ensemble de mesures de gestion des m\u00e9dicaments. Toutefois, en raison des effectifs et de la charge de travail actuels, les pharmaciens ne sont pas en mesure d\u2019effectuer le BCM au moment du cong\u00e9 pour tous les patients hospitalis\u00e9s. Par cons\u00e9quent, il est n\u00e9cessaire de classer les patients par ordre de priorit\u00e9 pour les interventions de BCM au moment du cong\u00e9 en fonction des besoins cliniques et du degr\u00e9 de risque.\nObjectifs : D\u00e9crire la fa\u00e7on dont les pharmaciens priorisent les patients en vue du BCM au moment du cong\u00e9 dans un h\u00f4pital tertiaire; cerner les obstacles \u00e0 l\u2019implication des pharmaciens et les facteurs qui facilitent leur implication dans cette d\u00e9marche; et comparer l\u2019\u00e9valuation de la priorit\u00e9 des patients par les pharmaciens avec les scores d\u00e9riv\u00e9s \u00e0 l\u2019aide des outils d\u2019\u00e9valuation PRIME, PADR-EC, et \u00ab risque de r\u00e9admission non pr\u00e9vue Epic \u00bb.\nM\u00e9thodologie : Les pharmaciens impliqu\u00e9s dans le BCM au moment du cong\u00e9 ont particip\u00e9 \u00e0 des groupes de discussion afin de se pencher sur leurs pratiques en la mati\u00e8re, notamment les facteurs pris en compte dans la priorisation des patients, les facteurs qui facilitent leur implication dans le BCM ainsi que les obstacles \u00e0 leur implication. Pour les patients pris en charge dans leur service et dont le cong\u00e9 \u00e9tait pr\u00e9vu dans les 48 heures, les pharmaciens ont utilis\u00e9 un questionnaire afin de classer la priorit\u00e9 du BCM au moment du cong\u00e9 et d\u2019indiquer leur intention de le r\u00e9aliser. Pour chaque patient, les scores Epic, PRIME et PADR-EC ont \u00e9t\u00e9 recueillis et compar\u00e9s aux \u00e9valuations des pharmaciens.\nR\u00e9sultats : Au total, 13 pharmaciens ont particip\u00e9 \u00e0 2 groupes de discussion, dont 11 pharmaciens ont rempli le questionnaire pour un total de 110 patients. Vingt-deux facteurs uniques et 27 sous-facteurs de priorisation des patients ont \u00e9t\u00e9 recens\u00e9s. Les cinq principaux facteurs \u00e9taient: la complexit\u00e9 du traitement m\u00e9dicamenteux, les m\u00e9dicaments \u00e0 haut risque, les modifications de la pharmacoth\u00e9rapie, l\u2019acc\u00e8s aux m\u00e9dicaments et la dur\u00e9e du s\u00e9jour. Les obstacles et les facilitateurs ont \u00e9t\u00e9 regroup\u00e9s en six th\u00e8mes: la dynamique de l\u2019\u00e9quipe, la charge de travail des pharmaciens, l\u2019implication ant\u00e9rieure des pharmaciens, le processus de BCM au moment du cong\u00e9, la planification des cong\u00e9s et la technologie. Les \u00e9valuations des pharmaciens semblaient diff\u00e9rer des scores obtenus avec les trois outils d\u2019\u00e9valuation du risque.\nConclusions : Les pharmaciens de l\u2019\u00e9tablissement \u00e9tudi\u00e9 n\u2019avaient pas d\u2019approche uniforme pour classer les patients par ordre de priorit\u00e9 en vue du BCM au moment du cong\u00e9. Les \u00e9tapes suivantes consisteront \u00e0 \u00e9laborer et \u00e0 tester un processus standardis\u00e9 de priorisation.\nMots-cl\u00e9s : bilan comparatif des m\u00e9dicaments, service de pharmacie, h\u00f4pital, pharmaciens, facteurs de risque, cong\u00e9 du patient<\/jats:p>","DOI":"10.4212\/cjhp.3936","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T16:51:55Z","timestamp":1788972715000},"source":"Crossref","is-referenced-by-count":0,"title":["Pharmacists\u2019 Prioritization of Patients for Discharge Medication Reconciliation at a Tertiary Academic Centre"],"prefix":"10.4212","volume":"79","author":[{"given":"Alexandra","family":"Goldstein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Shea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olavo","family":"Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Newman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Spec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"MacDonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2732","published-online":{"date-parts":[[2026,9,9]]},"container-title":["Canadian Journal of Hospital Pharmacy"],"original-title":[],"link":[{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3936\/5950","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3936\/5957","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3936\/5950","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T16:51:57Z","timestamp":1788972717000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/view\/3936"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":0,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9,9]]}},"URL":"https:\/\/doi.org\/10.4212\/cjhp.3936","relation":{},"ISSN":["1920-2903","0008-4123"],"issn-type":[{"value":"1920-2903","type":"electronic"},{"value":"0008-4123","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"article-number":"e3936"}}