Clinical Pharmacist-Led Bundled Care Model on Preventable Polypharmacy and Cost Avoidance

This study aims to evaluate whether a clinical pharmacist-led bundled care model can improve medication use and health outcomes in hospitalized adult patients with preventable polypharmacy. Preventable polypharmacy refers to the use of multiple medications when some may no longer be necessary, may be inappropriate, or may increase the risk of medication-related harm. Participants will be randomly assigned to receive either the pharmacist-led bundled care intervention in addition to usual hospital care or usual hospital care alone. The intervention includes comprehensive medication reconciliation, assessment of medication appropriateness, identification of potentially inappropriate medications, individualized deprescribing recommendations when appropriate, patient and caregiver education, discharge medication reconciliation, and follow-up after hospital discharge. The study will compare important clinical outcomes between the two groups, including hospital readmissions, emergency department visits, adverse drug events, medication appropriateness, quality of prescribing, and healthcare costs. The findings will help determine whether integrating a clinical pharmacist-led bundled care model into routine hospital practice can improve patient safety, optimize medication use, and reduce unnecessary healthcare utilization.

Inclusion Criteria: * Adults aged 18 years or older. * Admitted under an adult medical specialty at one of the participating hospitals. * Receiving five or more regular medications at the time of hospital admission. * Expected hospital stay of at least 48 hours. * Able and willing to provide written informed consent. Exclusion Criteria: * Admission under obstetric, pediatric, or psychiatric services. * Admission to an intensive care unit. * Terminal illness with an expected survival of less than three months. * Unable to provide informed consent and without an available legal representative. * Declines participation in the study.