Implementation of post-discharge pharmaceutical consultation for liver transplant patients
DOI:
https://doi.org/10.30968/jhphs.2025.164.1284Abstract
Objective: To describe the implementation process of a pharmaceutical guidance program during the transition of care, conducted by pharmacists at hospital discharge and post-discharge for patients undergoing liver transplantation. Methods: A prospective, descriptive, single-group study was conducted in a liver transplant ward of a high-complexity tertiary hospital located in the city of São Paulo, Brazil, from September to November 2024. Liver transplant patients received discharge instructions from trained pharmacists and were reassessed in post-discharge pharmaceutical consultations regarding adherence and the presence of medication-related problems. Post-discharge consultations were conducted in person or via telehealth. Patients who presented with medication-related problems after reassessment were maintained under pharmacotherapeutic follow-up; the others were discharged from pharmaceutical care. Results: 17 patients participated in the study. There was a predominance of men (64.71%), a preference for teleconsultation (70.59%), and a good average medication adherence rate (92.48%). The most frequently found medication-related problem (MRP) was convenience, related to access to medications (37.04%). Five patients were maintained under follow-up in the pharmacy outpatient clinic. Conclusions: The implementation of the post-discharge pharmaceutical guidance program proved to be feasible, structured, and capable of identifying medication-related problems early, especially those related to access. The study reinforces the essential role of the pharmacist in the transition and continuity of care, given the complexity of pharmacotherapy for these patients.
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