Impact of the Lund Integrated Medicines Management model on medication appropriateness

• Introduction Inappropriate prescribing among elderly patients may increase the risk for drug-related problems. The objective of this study was to examine the impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness in hospitalised patients. Materials & Methods A prospective controlled study of 210 elderly patients, from three internal medicine wards in a Swedish hospital. We compared patients receiving Medication Reviews, including Admission Medication Reconciliation, according to the LIMM-model, with patients receiving standard care. The LIMMmodel was implemented at one ward at a time between January 2007 and March 2008. We chose four dates for inclusion of patients during this period, one date before implementation and three dates about one month after implementation on the first, second and third ward, respectively. All patients who were staying at any of the wards on  these dates were eligible for inclusion. The main outcome measure was the change, from admission to discharge, in the number of drugs with at least one inappropriate rating, according to the Medication Appropriateness Index (MAI). The MAI consists of 10 criteria: indication, effectiveness, dosage, correct directions, practical directions, drug-drug interactions, drug-disease interactions, duplication, duration and expense. For intervention patients, the MAI assessment at discharge was performed in two steps. Step 1, which was a blinded assessment based on information in the patient’s medical record, was used in the main analysis. In step 2, the drugs were reassessed (unblinded), by adding information from the pharmacists’ Medication Review Forms that had not been documented in the medical records. Results The control and intervention group were similar regarding baseline demographic data. The mean number of drugs with at least one inappropriate rating decreased from 3.0 at admission to 1.5 at discharge in the intervention group, and from 2.8 to 1.7 in the control group. This represented a 51% (95% CI, 43-58%) decrease in the intervention group (step 1 assessment), compared to a 39% (95% CI, 30-48%) decrease in the control group (p = 0.0446, Poisson regression). In the assessment step 2, the MAI rating was changed from ‘inappropriate’ to ‘appropriate’ in 23% of the drugs (27/117). The mean decrease per patient between step 1 and 2 in number of drugs with at least one inappropriate rating was 0.38 (95% CI 0.22–0.54). In both control and intervention patients the most common MAI problems involved ‘expense’, ‘indication’ and ‘duration’. Discussion & Conclusion This study showed that medication appropriateness at discharge from hospital improved in patients receiving Medication Reviews and Reconciliation, according to the LIMM-model. In order to take full advantage of the work done by the clinical pharmacists, the information documented in the Medication Review Forms should also be documented in the medical records.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Medicinska och farmaceutiska grundvetenskaper -- Samhällsfarmaci och klinisk farmaci (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Basic Medicine -- Social and Clinical Pharmacy (hsv//eng)

Keyword

Clinical pharmacy services

Medication Appropriateness Index

Medication review

Medication reconciliation

Drug-related problems

Inpatients

Klinisk farmaci

Olämpliga läkemedel

Läkemedelsgenomgångar

Läkemedelsavstämning

Läkemedelsrelaterade problem

Sjukhus

Patient

Community pharmacy services

Samhällsfarmaci

Pharmacology

Farmakologi

Publication and Content Type

ref (subject category)

kon (subject category)