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Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model – impact on all cause emergency department revisits
Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences. (eHälsoinstitutet ; eHealth Institute)
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. (eHälsoinstitutet ; eHealth Institute)ORCID iD: 0000-0002-4295-7201
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2012 (English)In: Journal of Clinical Pharmacy and Therapeutics, ISSN 0269-4727, E-ISSN 1365-2710, Vol. 37, no 6, 686-692 p.Article in journal (Refereed) Published
Abstract [en]

What is known and objective: Interventions involving medication reconciliation and review by clinical pharmacists can reduce drug-related problems and improve therapeutic outcomes. The objective of this study was to examine the impact of routine admission medication reconciliation and inpatient medication review on emergency department (ED) revisits after discharge. Secondary outcomes included the combined rate of post-discharge hospital revisits or death.

Methods: This prospective, controlled study included all patients hospitalised in three internal medicine wards in a university hospital, between January 1 2006 and May 31 2008. Medication reconciliation on admission and inpatient medication review, conducted by clinical pharmacists in a multiprofessional team, were implemented in these wards at different times during 2007 and 2008 (intervention periods). A discharge medication reconciliation was undertaken in all the study wards, during both control and intervention periods. Patients were included in the intervention group (n=1216) if they attended a ward with medication reconciliation and review, whether they had received the intervention or not. Control patients (n=2758) attended the wards before implementation of the intervention. 

Results: No impact of medication reconciliation and reviews on ED revisits (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.86-1.04) or event-free survival (HR, 0.96; 95% CI, 0.88-1.04) was demonstrated. In the intervention group, 594 patients (48.8%) visited the ED, compared to 1416 (51.3%) control patients. In total, 716 intervention (58.9%) and 1688 (61.2%) control patients experienced any event (ED visit, hospitalisation or death). Because the time to a subsequent ED visit was longer for the control as well as the intervention groups in 2007 than in 2006 (p<0.05), we re-examined this cohort of patients; the proportion of patients revisiting the ED was similar in both groups in 2007 (p=0.608).

What is new and conclusion: Routine implementation of medication reconciliation and reviews on admission and during the hospital stay did not appear to have any impact on ED revisits, rehospitalisations or mortality over six months' follow-up.  

Place, publisher, year, edition, pages
2012. Vol. 37, no 6, 686-692 p.
Keyword [en]
Medications, hospital, medication review, medication reconciliation, pharmacist, clinical pharmacy, multiprofessional team, LIMM-model, readmission
Keyword [sv]
Läkemedel, sjukhus, läkemedelsgenomgångar, läkemedelsavstämning, apotekare, klinisk farmaci, multiprofessionellt team, LIMM-modellen, återinläggning
National Category
Social and Clinical Pharmacy
Research subject
Natural Science, Biomedical Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-21947DOI: 10.1111/jcpt.12001Scopus ID: 2-s2.0-84868369185OAI: oai:DiVA.org:lnu-21947DiVA: diva2:559254
Available from: 2012-10-08 Created: 2012-10-08 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Clinical pharmacy services within a multiprofessional healthcare team
Open this publication in new window or tab >>Clinical pharmacy services within a multiprofessional healthcare team
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital.

Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate.

Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated.

Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced.

Place, publisher, year, edition, pages
Växjö, Kalmar: Linnaeus University Press, 2012. 63 p.
Series
Linnaeus University Dissertations, 84/2012
Keyword
Clinical pharmacy services, pharmacist, medication review, medication reconciliation, medication errors, drug-related problems, inappropriate prescribing, elderly, inpatients, patient readmissions, hospitalisation, multiprofessional, patient care team, continuity of patient care, Klinisk farmaci, farmaceut, läkemedelsgenomgång, läkemedelsavstämning, läkemedelsfel, läkemedelsrelaterade problem, olämpliga läkemedel, äldre, återinläggning, sjukhusinläggning, multiprofessionell, vårdteam, kontinuitet i vården
National Category
Social and Clinical Pharmacy
Research subject
Natural Science, Biomedical Sciences
Identifiers
urn:nbn:se:lnu:diva-18293 (URN)978-91-86983-47-5 (ISBN)
Public defence
2012-05-16, N2007, Västergård, Smålandsgatan 26E, Kalmar, 13:00 (Swedish)
Opponent
Supervisors
Projects
Läkemedelsgenomgångar och läkemedelsavstämning - LIMM-modellen
Available from: 2012-04-12 Created: 2012-04-11 Last updated: 2017-01-19Bibliographically approved

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Publisher's full textScopushttp://onlinelibrary.wiley.com/doi/10.1111/jcpt.12001/abstract;jsessionid=DA794D38092EA401CD018A321910F847.d02t03

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Hellström, LinaPetersson, Göran

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