Insufficient communication about medication use at the interface between hospital and primary care

Abstract

Background: Lack of updated and uniform medication lists poses a problem for the continuity in patient care. The aim of this study was to estimate whether hospitals succeed in making accurate medication lists congruent with patients' actual medication use. Subsequently, the authors evaluated where errors were introduced and the possible implications of incongruent medication lists. Methods: Patients were visited within one week after discharge from surgical or medical department and interviewed about their use of prescription-only medication (POM). Stored drugs were inspected. Medication lists in hospital files and discharge letters were compared with the list obtained during the interview. The frequency of incorrect medication use and the potential consequences were estimated. Results: A total of 83 surgical and 117 medical patients were included (n = 200), 139 patients (70%) were women. Median age was 75 years. Six patients stored no POM, 194 patients stored 1189 POM. Among the 955 currently-used POM, 749 POM (78%) were registered at some point during hospitalisation but only 444 (46%) were registered in discharge letters. 66 POM users had no medication list in their discharge letter. Local treatments (skin, eyes, airways) were registered less frequently than drugs administered orally. In total, 179 of the currently-used POM (19%) were not mentioned anywhere in hospital files, probably because of insufficient medication lists made at admission, and the prescribed regimen was unclear. At least 63 POM (7% of currently-used POM) were used in disagreement with the prescribed regimen. Discussion: Approximately one fifth of used POM is unknown to the hospital and only half of used POM registered in discharge letters. Insufficient medication lists hamper clarifying whether or not patients use medication according to prescription. In order to prevent medication errors a systematic follow-up after discharge focusing on making an updated medication list might be needed.

Interdisciplinary collaboration in the provision of a pharmacist-led discharge medication reconciliation service at an Irish teaching hospital

“…Investigation of the 471 relative contributions of the clinical pharmacist and NCHD 472 to the resolution of these non-reconciliations is a novel 473 aspect of this research and as such is not directly compa-474 rable to other studies in the field. 475 Substantial changes to patient's medications during their 476 inpatient stay and a clear absence of complete and accurate 477 information about many of these changes at discharge has 478 been demonstrated in this study, as is widely documented 479 in research literature [13,21,22]. Through review of dis-480 charge prescriptions, the clinical Pharmacist identified 481 prescription non-reconciliations on 62.5 % of prescriptions 482 and for 15.8 % of medications, and communication non-483 reconciliations on 92 % of prescriptions and for 45.8 % of 484 medications.…”

Changes in drug therapy following hospital discharge for patients in a general practice: a German incident study

“…However, in Germany it is far from reality and difficult to put into practice. Besides improvement in communication between family and hospital doctors via transmission of more detailed information about drug changes to the discharge medication list (Clintborg et al 2007;Gonski et al 1993), perhaps more patient information, such as pharmaceutical counseling and better informing of patients concerning their pharmaceutical care plan, might be helpful to reduce posthospital drug prescribing (Al-Rashed et al 2002;Sorensen et al 2004). Furthermore, use of modern media like the world-wide web in primary care practices opens up new possibilities for better maintenance of adequate drug treatment after hospital discharge.…”

Eczacılıkta İletişimin Rolü

“…Çeşitli hastalıkların artması ve yaşlanan nüfus ile birlikte, polifarmasi uygulamalarının da gittikçe arttığı ve reçete edilen ilaçlar hakkında hastaların yetersiz bilgiye sahip olması, sonucunda, istenmeyen yan etkilerin ortaya çıktığı bilinmektedir. Dolayısıyla, uygun olmayan ilaç kullanımını ve advers ilaç etkilerini önlemek için de eczacı hasta iletişimi önemlidir (43). Çalışmalar, hasta çıktılarında ve uyuncunda artışın, reçete edilen ilaç sayısında ve ilaçla ilgili problemlerin azalışının eczacı-hasta iletişiminin etkinliğinin rolü olduğunu göstermektedir (38).…”