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- Hellström, Lina, et al.
(author)
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Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits.
- 2011
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In: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 67:7, s. 741-752
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Journal article (peer-reviewed)abstract
- PurposeTo examine the impact of systematic medication reconciliations when admitted to hospital, and medication review while in hospital, on the number of inappropriate medications and unscheduled drug-related hospital revisits in elderly patients.MethodsA 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. Patients received either standard care or care according to the Lund Integrated Medicines Management (LIMM) model. A multi-professional team, including a clinical pharmacist, provided medication reconciliations on admission and medication reviews during the hospital stay for the LIMM group. 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 three months of discharge (using WHO 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 34-52 %], 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 multi-professional team significantly reduced the number of inappropriate drugs and unscheduled drug-related hospital revisits for elderly patients.
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| 2. |
- Midlöv, Patrik, et al.
(author)
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The effect of medication reconciliation in elderly patients at hospital discharge.
- 2012
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In: International Journal of Clinical Pharmacy. - : Springer Science and Business Media LLC. - 2210-7703 .- 2210-7711. ; 34:1, s. 113-119
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Journal article (peer-reviewed)abstract
- Objective To assess the impact of medication reconciliation interventions on medication error rates when elderly patients are discharged from hospital to community care or nursing homes.Setting Elderly patients (>65 years) living in nursing homes or in their own homes with care provided by the community nursing system. Method All medical records containing information on drug treatment were collected from hospital departments, the community care service and GPs. We then identified if there were any changes in the transfer of information i.e. if the drugs were not the same as before the transfer. Two different persons independently evaluated all information about the patients' drugs to identify medication errors for three different time periods. During all three periods structured discharge information was used. In period 2, electronic medication lists were introduced and in period 3 we introduced specific routines and support by a clinical pharmacist to ensure prescription in the specific medication dispensing system (ApoDos). Asymptotic Linear by-Linear Association Test was used to compare number of medication errors in period 1, 2 and 3 respectively. Main outcome measure Number of medication errors per patient. Results A total of 123 patients were evaluated at discharge. For the 109 patients using the ApoDos system, there were significant differences in the number of medication errors between period 1 and 3 (P = 0.048), period 2 and 3 (P = 0.037 but not between period 1 and 2 (P = 0.41). The mean numbers of errors were 1.5, 1.1 and 0.5 for period 1, 2 and 3 respectively. The 14 patients not using the ApoDos system had on average 0.4 errors per patient. Among the 58 patients with medication errors, 34 were evaluated as having low clinical risk, 22 moderate, and 2 high clinical risk. Conclusion Medication errors are still common when elderly patients are transferred from hospital to community/primary care. The main risk factor seems to be the specific medication dispensing system (ApoDos) or rather the process on how to use it. When this system was supported by clinical pharmacists, the error rate dropped to the same level as for patients without ApoDos.
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