Using a structured reconciliation medication form improves medication transition from hospital to community care and primary care physicians’ adherence with medication adaptations and recommendations
Abstract
Background
Hospital admission and discharge are weakness points in the transition of care.
Objective
To lower the risk of errors and improve medication information transfer to primary care physician (PCP), we conducted an experimental study using a structured medication reconciliation form (SMRF) in an Acute Care for Elders unit.
Results
1242 drugs of 173 patients were reconciliated at admission, optimized during the stay, and transmitted via the SMRF to the 143 corresponding PCPs. While the optimization led to 779 adaptations from admission to discharge, of which 39.0% were omissions, exposure to polypharmacy was reduced from 83.2 to 74.6% (P < 0.05). One-month post-discharge, with an answer rate of 62.2% among PCPs, the adherence to recommendations was high (85.0%) and the exposure to polypharmacy was further decreased (67.7%; P < 0.05).
Conclusion
These results provide elements to consider SMRF as an example of good practice for which the impact should be analyzed at larger scale.
Keywords
Medication reconciliation form Hospital Transition of care Aged patientNotes
Acknowledgements
Sponsor’s role: there was no sponsor for this manuscript.
Author contributions
CP, CPh and GX have designed the study. JD, CP, CPh, CC, GX, and POL have analyzed the data. JD, CP, GX, CC, CPh, and POL have written the manuscript.
Compliance with ethical standards
Conflict of interest
None of the authors has any conflict of interest to declare.
Ethical approval
The local ethic committee approved this experimental protocol. All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
An informed consent was obtained from all particpants (eligible patients and PCPs).
References
- 1.Pronovost P, Weast B, Schwarz M, Pronovost P, Weast B, Schwarz M (2003) Medication reconciliation: a practical tool to reduce the risk of medication errors. J Crit Care 18:201–205CrossRefGoogle Scholar
- 2.Kanaan AO, Donovan JL, Duchin NP, Field TS, Tjia J, Cutrona SL, Gagne SJ, Garber L, Preusse P, Harrold LR, Gurwitz JH (2013) Adverse drug events after hospital discharge in older adults: types, severity, and involvement of Beers Criteria Medications. J Am Geriatr Soc 61:1894–1899CrossRefGoogle Scholar
- 3.Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, Cadoret C, Fish LS, Garber L, Kelleher M, Bates DW (2003) Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 289:1107–1116CrossRefGoogle Scholar
- 4.Takeda-Raguin CVT, Ferahta N, Smith C, Poloni B, Lang PO (2016) Adherence to long-term drug regimen after hospital discharge: general practitioners’ attitude. J Am Geriatr Soc 64:657–659CrossRefGoogle Scholar
- 5.Almanasreh E, Moles R, Chen TF (2016) The medication reconciliation process and classification of discrepancies: a systematic review. Br J Clin Pharmacol 82:645–658CrossRefGoogle Scholar
- 6.Colloque HAS (2018) Appropriateness of care, moving from concept to action—Paris—November 14, 2017. (Accessed August 13, 2018, at https://www.has-sante.fr/portail/jcms/c_2798336/en/colloque-has-appropriateness-of-care-moving-from-concept-to-action-paris-november-14-2017.)
- 7.Desnoyer A, Guignard B, Lang PO, Desmeules J, Vogt-Ferrier N, Bonnabry P (2016) Potentially inappropriate medications in geriatrics: Which tools to detect them? Presse Med 45:957–970CrossRefGoogle Scholar
- 8.O’Mahony D, Gallagher P, Ryan C, Byrne S, Hamilton H, Barry P, O’Connor M, Kennedy J (2010) STOPP & START criteria: a new approach to detecting potentially inappropriate prescribing in old age. Eur Geriatr Med 1:45–51CrossRefGoogle Scholar
- 9.Boudon A, Riat F, Rassam-Hasso Y, Lang PO (2017) Polymorbidité et polypharmacie: comment optimizer la prise en charge des patients âgés complexes? Swiss Med Forum 17:306–312Google Scholar
- 10.Lang PO, Farhat A, Csajka C (2017) Optimizing one’s prescriptions: which approach, which tool to use? Rev Geriatr 42:1–12Google Scholar
- 11.Lang PO, Petrovic M, Dalleur O, Ferahta N, Benetos A, Boland B (2016) The exercise in applying STOPP/START.v2 in vulnerable very old patients: towards patient tailored prescribing. Eur Geriatr Med 7:176–179CrossRefGoogle Scholar
- 12.Ensing HT, Koster ES, van Berkel PI, van Dooren AA, Bouvy ML (2017) Problems with continuity of care identified by community pharmacists post-discharge. J Clin Pharm Ther 42:170–177CrossRefGoogle Scholar
- 13.Lam P, Elliott RA, George J (2011) Impact of a self-administration of medications programme on elderly inpatients’ competence to manage medications: a pilot study. J Clin Pharm Ther 36:80–86CrossRefGoogle Scholar