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

Hellström, Lina M; Bondesson, Åsa ÅB LU ; Höglund, Peter LU ; Midlöv, Patrik LU ; Holmdahl, Lydia; Rickhag, Eva and Eriksson, Tommy LU (2011) In European Journal of Clinical Pharmacology 67. p.741-752
Abstract
PURPOSE: To 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 drug-related hospital revisits in elderly patients. METHODS: This 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 model (medication reconciliation upon admission and discharge, and medication review and monitoring) provided by a multi-professional team, including a clinical pharmacist. Control patients received standard care and medication... (More)
PURPOSE: To 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 drug-related hospital revisits in elderly patients. METHODS: This 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 model (medication reconciliation upon admission and discharge, and medication review and monitoring) provided by a multi-professional team, including a clinical pharmacist. Control patients received standard care and medication reconciliation upon 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). RESULTS: There 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% confidence interval (CI) 43-58%] vs. 39% (95% CI 30-48%); p = 0.0446} and the per-protocol population [60% (95% CI 51-67%) vs. 44% (95% CI 34-52%); p = 0.0106)]. There were six 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). CONCLUSIONS: In this study, medication reconciliation and review provided by a clinical pharmacist in a multi-professional team significantly reduced the number of inappropriate drugs and unscheduled drug-related hospital revisits among elderly patients. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Clinical Pharmacology
volume
67
pages
741 - 752
publisher
Springer
external identifiers
  • wos:000291602700012
  • pmid:21318595
  • scopus:79959707163
ISSN
1432-1041
DOI
10.1007/s00228-010-0982-3
language
English
LU publication?
yes
id
1c26150b-4248-48ec-9440-d2e33006a28b (old id 1831867)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21318595?dopt=Abstract
date added to LUP
2011-03-01 14:55:59
date last changed
2017-11-12 03:38:32
@article{1c26150b-4248-48ec-9440-d2e33006a28b,
  abstract     = {PURPOSE: To 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 drug-related hospital revisits in elderly patients. METHODS: This 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 model (medication reconciliation upon admission and discharge, and medication review and monitoring) provided by a multi-professional team, including a clinical pharmacist. Control patients received standard care and medication reconciliation upon 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). RESULTS: There 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% confidence interval (CI) 43-58%] vs. 39% (95% CI 30-48%); p = 0.0446} and the per-protocol population [60% (95% CI 51-67%) vs. 44% (95% CI 34-52%); p = 0.0106)]. There were six 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). CONCLUSIONS: In this study, medication reconciliation and review provided by a clinical pharmacist in a multi-professional team significantly reduced the number of inappropriate drugs and unscheduled drug-related hospital revisits among elderly patients.},
  author       = {Hellström, Lina M and Bondesson, Åsa ÅB and Höglund, Peter and Midlöv, Patrik and Holmdahl, Lydia and Rickhag, Eva and Eriksson, Tommy},
  issn         = {1432-1041},
  language     = {eng},
  pages        = {741--752},
  publisher    = {Springer},
  series       = {European Journal of Clinical Pharmacology},
  title        = {Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits.},
  url          = {http://dx.doi.org/10.1007/s00228-010-0982-3},
  volume       = {67},
  year         = {2011},
}