UMEM Educational Pearls - By Lena Carleton

Medication-related adverse events account for an estimated 2 million Emergency Department (ED) visits annually in the United States. This study evaluated whether a pharmacist-led intervention could reduce ED return visits for medication-related events.

In this open-label, parallel-group randomized clinical trial, 330 adults were enrolled at a single university hospital in France between 2018 and 2021. Medication-related events were categorized as adverse drug events without misuse (e.g., drug reactions or interactions), adverse drug events with misuse, and nonadherence-related events.

Patients were randomized to a pharmacist-led transition-of-care intervention or usual care. In the intervention group, an ED pharmacist obtained a medication history and contacted the patient’s general practitioner and community pharmacist by phone and letter with details of the event and management recommendations; estimated intervention time was approximately 60 minutes per patient. Usual care included a medication history and a standard ED discharge letter to the general practitioner.

The primary outcome was ED return visits for the same medication-related adverse event within 6 months. Secondary outcomes included all-cause ED visits, outpatient visits, hospitalizations, and death.

The intervention group had a 19% reduction in ED return visits for medication-related adverse events attributed to the same medication as the initial ED visit, with similar reductions in all medication-related ED visits and hospitalizations. There were no significant differences in all-cause hospitalization or mortality between the intervention and control groups.

Notable barriers to implementation included the time-intensive nature of the intervention (approximately 60 minutes per patient) and the absence of a shared medical record to facilitate communication between ED and outpatient pharmacists and clinicians.

Key Takeaway: Improved communication between ED teams, outpatient physicians, and pharmacists may reduce recurrent ED visits for medication-related adverse events.

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Treatment of Staphylococcus aureus bacteremia has traditionally required several weeks of intravenous antibiotics. This approach carries medical risks, such as catheter-associated infection or thrombosis, as well as significant social and financial burdens for patients. Dalbavancin, a long-acting intravenous lipoglycopeptide with activity against S. aureus (including MRSA), has been proposed as a more convenient alternative. This study evaluated the efficacy and safety of dalbavancin compared with standard therapy for S. aureus bacteremia.

Two hundred adults were enrolled in this open-label, randomized clinical trial, which was conducted in the United States and Canada. After blood cultures cleared, participants were randomized to complete therapy with dalbavancin (administered on Days 1 and 8) or with standard treatment (cefazolin for MSSA and vancomycin or daptomycin for MRSA).

The primary outcome was the Desirability of Outcome Ranking (DOOR) at Day 70, incorporating five domains: clinical success, infectious complications, safety events, mortality, and health-related quality of life.

Dalbavancin was not superior to standard therapy for treating S. aureus bacteremia, and adverse events were similar between groups. A key strength of this study was the inclusion of people who inject drugs, a population at high risk for S. aureus bacteremia and often underrepresented in trials. A major limitation was that the DOOR metric did not account for important social and economic factors, such as disposition (home versus skilled nursing facility), caregiver burden, or treatment cost.

Key Takeaway: Dalbavancin may be a suitable alternative to traditional therapy for Staphylococcus aureus bacteremia, offering less frequent dosing and a shorter treatment course. Further research is needed to identify which patients benefit most and to evaluate its impact on social and economic factors such as discharge disposition, caregiver burden, and treatment costs.

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