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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.

Hellström, Lina; Höglund, Peter LU ; Bondesson, Åsa ÅB LU ; Petersson, G and Eriksson, Tommy LU (2012) In Journal of Clinical Pharmacy and Therapeutics 37(6). p.686-692
Abstract
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 hospitalized in three internal medicine wards in a university hospital, between 1 January 2006 and 31 May 2008. Medication reconciliation on admission and inpatient medication review, conducted by clinical pharmacists in a... (More)
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 hospitalized in three internal medicine wards in a university hospital, between 1 January 2006 and 31 May 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 and Discussion: 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 with 1416 (51·3%) control patients. In total, 716 intervention (58·9%) and 1688 (61·2%) control patients experienced any event (ED visit, hospitalization 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, re-hospitalizations or mortality over 6-month follow-up. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Clinical Pharmacy and Therapeutics
volume
37
issue
6
pages
686 - 692
publisher
Wiley-Blackwell
external identifiers
  • wos:000310601200013
  • pmid:22924464
  • scopus:84868369185
ISSN
0269-4727
DOI
10.1111/jcpt.12001
language
English
LU publication?
yes
id
ee9b0f7c-2ec7-4b0d-a4e0-370b4499d7ae (old id 3047170)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22924464?dopt=Abstract
date added to LUP
2012-09-05 21:17:48
date last changed
2017-04-16 04:23:03
@article{ee9b0f7c-2ec7-4b0d-a4e0-370b4499d7ae,
  abstract     = {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 hospitalized in three internal medicine wards in a university hospital, between 1 January 2006 and 31 May 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 and Discussion: 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 with 1416 (51·3%) control patients. In total, 716 intervention (58·9%) and 1688 (61·2%) control patients experienced any event (ED visit, hospitalization 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 &lt; 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, re-hospitalizations or mortality over 6-month follow-up.},
  author       = {Hellström, Lina and Höglund, Peter and Bondesson, Åsa ÅB and Petersson, G and Eriksson, Tommy},
  issn         = {0269-4727},
  language     = {eng},
  number       = {6},
  pages        = {686--692},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of Clinical Pharmacy and Therapeutics},
  title        = {Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model - impact on all-cause emergency department revisits.},
  url          = {http://dx.doi.org/10.1111/jcpt.12001},
  volume       = {37},
  year         = {2012},
}