Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

Abstract

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.

Clinical pharmacist service in the acute ward

“…It has been described how clinical pharmacists (CPs) participate in various stages of the medication process such as compiling the medication history [14], medication reconciliation [15] and performing medication reviews [12,16] and clinical pharmacy may benefit all stages of the medication process [4,6,[17][18][19][20][21][22][23].…”

Acceptance and importance of clinical pharmacists’ LIMM-based recommendations

“…The full LIMM-based clinical pharmacy service has been described previously by Hellström et al [1]. Briefly, on week days, a clinical pharmacist reconciled patient medications shortly after the patient was admitted, and reviewed and monitored the medications during the hospital stay.…”

“…When following the model, clinical pharmacists are responsible for conducting a full medication review, including reconciliation of medications on admission. Previous studies have associated improved appropriateness of medications and reduced unscheduled drug-related hospital revisits with the LIMM system [1]; however, it is also important to establish the acceptance and clinical relevance of the recommendations made by clinical pharmacists using the model.…”

Improving the quality of prescribing in elderly hospital inpatients: evaluating the effect of a clinical pharmacist on ward rounds

“…Pharmacological treatment is an important component of medical care for the elderly and whilst potentially beneficial it also has the potential to decrease morbidity and mortality and increase quality of life 12 . Problems associated with pharmacological treatment are frequent among elderly hospitalised patients and for a significant number of patients it can lead to a medication-related hospital admission 12 .…”