Pharmacist-Led Transition of Care Program in the Emergency Department (Pharm TOC-ED): A Pilot Trial

Inclusion Criteria: * Adults (aged 18 years or more) discharged from the ED with at least one of the following: * Polypharmacy: Five or more scheduled prescription medications for chronic illnesses (i.e., chronic maintenance medications, even if such medications were not refilled during the index ED visit) * Discharged with a new prescription of high-risk medication, including: * Drugs with the potential of withdrawal symptoms upon abrupt discontinuation such as antipsychotics, antiepileptics, antidepressants, and tapering glucocorticoids. * Insulin (initiation or intensification of therapy) * Oral hypoglycemic agents * Visiting ED for an exacerbation of chronic illness (e.g., exacerbation of asthma, COPD, CHF, uncontrolled diabetes mellitus, hypertension urgency, uncontrolled epilepsy) Exclusion Criteria: * The following patients will be excluded: * Presenting with acute minor illnesses * Lack of decision-making capacity (including documented moderate or severe dementia, altered mental status, unstable psychiatric illness, altered consciousness level, lack of orientation to person/place/time as reported in EHR, delirium, patients seen in the ED for a psychiatric evaluation) * Language barrier, i.e., inability to communicate in either English or Arabic as the intervention will be provided by English/Arabic speaking clinical pharmacists * Expected length of stay in Qatar of \<30 days post discharge (including transit passengers) * Substance use disorders (e.g., alcoholism, opioid dependency) or drug-seeking behavior, as reported in EHR * Prisoners who are serving an active sentence * Patients presenting for non-medical, socially driven reasons (e.g., seeking shelter, support, or resources) with no identifiable acute medical condition, and known to the ED team as recurrent visitors. * Discharge to a location other than home (e.g., patients transferred to another hospital, long-term or skilled nursing facility) * Study pharmacists unavailable to deliver the intervention if the patients were randomized to the intervention arm * Pregnant women * Patients seen for trauma or planned surgery * Terminally ill patients * Patients discharged from ED with watchful waiting (e.g., expected to be readmitted for an intervention such as surgical intervention if conservative management failed) * Patients who are admitted to the hospital after enrollment (i.e., following consent but prior to ED discharge)