{
  "abstract": "Background and Importance Pharmaceutical care programs are central to hospital pharmacy practice, supporting rational medicine use, adherence, and the detection of adverse drug reactions (ADRs). Pharmacist-led interventions have been associated with improved adherence, but long-term evaluations in hospital settings remain limited. Comprehensive medication management (CMM) provides a structured framework to deliver pharmaceutical care, ensuring medicines are appropriate, effective, safe, and used as intended.Aim and Objectives To evaluate the performance of a hospital pharmacy-led CMM program from 2020 to 2025, with emphasis on adherence support, pharmacovigilance, and patient engagement.Material and Methods This observational descriptive study analysed the hospital pharmacy CMM database (January 2020–June 2025). Variables included diagnoses, pharmacotherapy, type of service delivered, and care plan status (completed, suspended, presumed active). Outcomes assessed were enrolment trends, diagnosis distribution, services provided, pharmacotherapy coverage, and patient retention.Results A total of 1,344 patients were enrolled between 2020 and 2025, with steady growth: 2020 (6%), 2021 (13%), 2022 (18%), 2023 (17%), 2024 (30%), and 2025 to date (16%). The most frequent diagnoses were osteoporosis (18%), prostate cancer (6%), chronic kidney disease (6%), and rheumatoid arthritis (5%), with other autoimmune diseases accounting for ~7%. About one-third of records lacked a coded diagnosis, reflecting a documentation limitation. The majority of interventions were recorded as control of dispensing (56%), which included pharmacist verification and counselling, complemented by structured follow-up (2%) and SPD support (1%). Care plan outcomes showed 38% completed, 35% suspended, and the remainder (≈27%, n=356) presumed active. Among these active patients, the median follow-up was 3 months (IQR: 0.5–6 months), with some exceeding 1 year, demonstrating sustained pharmacist engagement. Pharmacotherapy included 177 unique medicines, frequently high-cost biologics such as denosumab (12%), secukinumab (8%), and epoetin beta (6%).Conclusion and Relevance The hospital pharmacy-led CMM program demonstrated sustained growth, broad therapeutic coverage, and contributions to adherence support and pharmacovigilance. While missing diagnoses and the predominance of dispensing records highlight opportunities to expand structured follow-up, the active cohort analysis confirms meaningful patient retention over time. This model strengthens patient safety and quality of care and may be adapted across healthcare systems to optimise pharmacotherapy outcomes.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Hospital Clinica Biblica, Hospital Pharmacy, San Jose, Costa Rica"
      ],
      "name": "E Zavaleta"
    },
    {
      "affiliations": [
        "Hospital Clinica Biblica, Comprehensive Medication Management, San Jose, Costa Rica"
      ],
      "name": "LC Monge-Bogantes"
    }
  ],
  "title": "4CPS-025 Hospital pharmacy-led comprehensive medication management: impact on adherence and safety",
  "uid": "6c5919c1-aec1-5070-b563-a0b819e15bac"
}