The study was funded by Apoteket AB and the County of Skåne, Sweden.
Abstract
PurposeTo examine the impact of systematic medication reconciliations upon hospital admission and of a medication review while in hospital on the number of inappropriate medications and unscheduled drugrelated hospital revisits in elderly patients.
MethodsThis was a prospective, controlled study in 210 patients, aged 65 years or older, who were admitted to one of three internal medicine wards at a University Hospital in Sweden. Intervention patients received the complete Lund Integrated Medicines Management (LIMM) model (medication reconciliation at admission and discharge, and medication reviews and monitoring) provided by a multi-professional team, including a clinical pharmacist. Control patients received standard care and medication reconciliation at discharge. Blinded reviewers evaluated the appropriateness of the prescribing (using the Medication Appropriateness Index) on admission and discharge, and assessed the probability that a drug-related problem was the reason for any patient readmitted to hospital or visiting the emergency department within 3 months of discharge (using World Health Organisation causality criteria).
ResultsThere was a greater decrease in the number of inappropriate drugs in the intervention group than in the control group for both the intention-to-treat population (51% [95% CI 43-58%] versus 39% [95% CI 30-48%], p=0.0446) and the per-protocol population (60% [95% CI 51-67%] versus 44% [95% CI 34-2 52 %], p=0.0106). There were 6 revisits to hospital in the intervention group which were judged as 'possibly, probably or certainly drug-related', compared with 12 in the control group (p=0.0469).
ConclusionIn this study, medication reconciliation and reviews provided by a clinical pharmacist in a multiprofessional team significantly reduced the number of inappropriate drugs and unscheduled drugrelated hospital revisits among elderly patients.
Medication errors are common when elderly patients are discharged from hospital. The Medication Report is a simple tool that reduces the number of medication errors.
This study provides further evidence of the quality of the LIMM model and confirms that the inclusion of clinical pharmacists in a multi-professional team can improve drug therapy for inpatients. The very high level of acceptance by the physicians of the pharmacists' recommendations further demonstrates the effectiveness of the process.
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