Pharmacist-led medication reconciliation at patient discharge: a tool to reduce healthcare utilization? an observational study in patients 65 years or older.
Adverse Drug Event
Discharge
Experience
Medication Reconciliation
Older people
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
13 07 2022
13 07 2022
Historique:
received:
05
01
2022
accepted:
31
05
2022
entrez:
13
7
2022
pubmed:
14
7
2022
medline:
16
7
2022
Statut:
epublish
Résumé
Older patients often experience adverse drug events (ADEs) after discharge that may lead to unplanned readmission. Medication Reconciliation (MR) reduces medication errors that lead to ADEs, but results on healthcare utilization are still controversial. This study aimed to assess the effect of MR at discharge (MRd) provided to patients aged over 65 on their unplanned rehospitalization within 30 days and on both patients' experience of discharge and their knowledge of their medication. An observational multicenter prospective study was conducted in 5 hospitals in Brittany, France. Patients who received both MR on admission (MRa) and MRd did not have significantly fewer deaths, unplanned rehospitalizations and/or emergency visits related to ADEs (OR = 1.6 [0.7 to 3.6]) or whatever the cause (p = 0.960) 30 days after discharge than patients receiving MRa alone. However, patients receiving both MRa and MRd were more likely to feel that their discharge from the hospital was well organized (p = 0.003) and reported more frequently that their community pharmacist received information about their hospital stay (p = 0.036). This study found no effect of MRd on healthcare utilization 30 days after discharge in patients over 65, but the process improved patients' experiences of care continuity. Further studies are needed to better understand this positive impact on their drug care pathway in order to improve patients' ownership of their drugs, which is still insufficient. Improving both the interview step between pharmacist and patient before discharge and the transmission of information from the hospital to primary care professionals is needed to enhance MR effectiveness. NCT04018781 July 15, 2019.
Sections du résumé
BACKGROUND
Older patients often experience adverse drug events (ADEs) after discharge that may lead to unplanned readmission. Medication Reconciliation (MR) reduces medication errors that lead to ADEs, but results on healthcare utilization are still controversial. This study aimed to assess the effect of MR at discharge (MRd) provided to patients aged over 65 on their unplanned rehospitalization within 30 days and on both patients' experience of discharge and their knowledge of their medication.
METHODS
An observational multicenter prospective study was conducted in 5 hospitals in Brittany, France.
RESULTS
Patients who received both MR on admission (MRa) and MRd did not have significantly fewer deaths, unplanned rehospitalizations and/or emergency visits related to ADEs (OR = 1.6 [0.7 to 3.6]) or whatever the cause (p = 0.960) 30 days after discharge than patients receiving MRa alone. However, patients receiving both MRa and MRd were more likely to feel that their discharge from the hospital was well organized (p = 0.003) and reported more frequently that their community pharmacist received information about their hospital stay (p = 0.036).
CONCLUSIONS
This study found no effect of MRd on healthcare utilization 30 days after discharge in patients over 65, but the process improved patients' experiences of care continuity. Further studies are needed to better understand this positive impact on their drug care pathway in order to improve patients' ownership of their drugs, which is still insufficient. Improving both the interview step between pharmacist and patient before discharge and the transmission of information from the hospital to primary care professionals is needed to enhance MR effectiveness.
TRIAL REGISTRATION
NCT04018781 July 15, 2019.
Identifiants
pubmed: 35831783
doi: 10.1186/s12877-022-03192-3
pii: 10.1186/s12877-022-03192-3
pmc: PMC9281036
doi:
Banques de données
ClinicalTrials.gov
['NCT04018781']
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
576Informations de copyright
© 2022. The Author(s).
Références
Br J Clin Pharmacol. 2010 Nov;70(5):749-55
pubmed: 21039769
Value Health. 2012 Sep-Oct;15(6):868-75
pubmed: 22999137
J Am Geriatr Soc. 2017 Jul;65(7):1401-1405
pubmed: 28369729
BMJ Open. 2016 Feb 23;6(2):e010003
pubmed: 26908524
Age Ageing. 2015 Mar;44(2):213-8
pubmed: 25324330
Pragmat Obs Res. 2017 May 12;8:49-55
pubmed: 28546780
Int J Clin Pharm. 2018 Oct;40(5):1154-1164
pubmed: 29754251
Res Social Adm Pharm. 2020 May;16(5):605-613
pubmed: 31395445
Pharm World Sci. 2010 Dec;32(6):759-66
pubmed: 20809276
Arch Intern Med. 2009 May 11;169(9):894-900
pubmed: 19433702
Br J Clin Pharmacol. 2015 Oct;80(4):796-807
pubmed: 25619317
Ann Intern Med. 2004 May 18;140(10):795-801
pubmed: 15148066
PLoS One. 2018 Mar 28;13(3):e0193510
pubmed: 29590146
BMC Health Serv Res. 2019 Oct 21;19(1):717
pubmed: 31638992
Pharm World Sci. 2002 Apr;24(2):46-54
pubmed: 12061133
Ann Intern Med. 2009 Feb 3;150(3):178-87
pubmed: 19189907
N Engl J Med. 2011 May 5;364(18):1685-7
pubmed: 21542739
Res Social Adm Pharm. 2018 Sep;14(9):805-811
pubmed: 29724680
Res Social Adm Pharm. 2014 Mar-Apr;10(2):355-68
pubmed: 24529643
Eur J Intern Med. 2020 Mar;73:100-102
pubmed: 31859024
J Am Geriatr Soc. 2013 Jan;61(1):113-21
pubmed: 23252914
CMAJ. 2004 Feb 3;170(3):345-9
pubmed: 14757670
Age Ageing. 2020 Jul 1;49(4):558-569
pubmed: 32043116
J Clin Pharm Ther. 2018 Jun;43(3):393-400
pubmed: 29446115
Res Social Adm Pharm. 2020 Jul;16(7):886-894
pubmed: 31607507
Europace. 2005 Sep;7 Suppl 2:118-27
pubmed: 16102509
Ann Intern Med. 2013 Mar 5;158(5 Pt 2):397-403
pubmed: 23460096
Can J Hosp Pharm. 2013 Nov;66(6):355-60
pubmed: 24357867
Res Social Adm Pharm. 2019 Oct;15(10):1212-1222
pubmed: 30389320
Arch Intern Med. 2006 Mar 13;166(5):565-71
pubmed: 16534045
Cochrane Database Syst Rev. 2018 Aug 23;8:CD010791
pubmed: 30136718
J Pharm Pract. 2021 Jun;34(3):354-359
pubmed: 31446826
BMJ Qual Saf. 2021 Feb;30(2):146-156
pubmed: 32434936
J Patient Saf. 2013 Sep;9(3):150-3
pubmed: 23965837
Eur J Clin Pharmacol. 2008 Jul;64(7):715-22
pubmed: 18385990
J Gen Intern Med. 2011 Jul;26(7):765-70
pubmed: 21373978
Res Social Adm Pharm. 2020 Aug;16(8):995-1002
pubmed: 31883776
J Am Geriatr Soc. 2017 Jan;65(1):212-219
pubmed: 27714762
Am J Health Syst Pharm. 2019 Dec 2;76(24):2028-2040
pubmed: 31789354
J Am Geriatr Soc. 2018 Mar;66(3):602-608
pubmed: 29468640
Eur J Intern Med. 2021 Jan;83:39-44
pubmed: 32773274
Int J Integr Care. 2021 Nov 08;21(4):16
pubmed: 34824565
J Hosp Med. 2016 Jan;11(1):39-44
pubmed: 26434752
Int J Evid Based Healthc. 2016 Sep;14(3):113-22
pubmed: 26886682
J Health Serv Res Policy. 2015 Jan;20(1):18-25
pubmed: 25256091
BMJ. 2008 Nov 11;337:a2390
pubmed: 19001484
Br J Clin Pharmacol. 2016 Dec;82(6):1660-1673
pubmed: 27511835
N Engl J Med. 2016 Aug 4;375(5):454-63
pubmed: 27518663
J Am Geriatr Soc. 2004 Nov;52(11):1817-25
pubmed: 15507057
BMJ. 2015 May 08;350:h2147
pubmed: 25956159