Secondary Prevention Bundle for Drug-Related Problems in an Integrated Healthcare Setting: A Pragmatic Observational Implementation-Effectiveness Study.

Abstract

This study evaluates the implementation and associated 30-day outcomes of the "Medication Code" (MC), a secondary prevention bundle for drug-related problems (DRPs), implemented at the Consorci Sanitari de Terrassa (CST), an integrated healthcare organization in Catalonia. The bundle, which combines medication reconciliation, structured medication review, and coordinated communication with primary care, was previously shown to reduce 30-day readmissions in a randomized trial at a large tertiary hospital. Between May 2024 and December 2025, 185 patients attending the emergency department (ED) at CST for a DRP received the secondary prevention intervention bundle. The study assesses the association between implementation of the recommendations and 30-day outcomes, not the effect of the MC bundle itself. Treatment optimization proposals were implemented in 72.4% of patients, either at discharge or during primary care follow-up, supported by a multiprofessional integrated team of pharmacists and primary care practitioners. Implementation of the pharmacotherapeutic proposals was associated with an absolut risk reduction of 30-day ED revisits and DRP-related readmissions. These findings are consistent with previous observations from the original MC program. However, because all included patients received the intervention bundle and outcomes were compared according to implementation status, the study cannot estimate the effectiveness of the MC bundle itself.