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Montaleytang M, Correard F, Spiteri C, Boutier P, Gayet S, Honore S, Villani P, Daumas A. Medication reconciliation in the geriatric unit: impact on the maintenance of post-hospitalization prescriptions. Int J Clin Pharm 2021; 43:1183-1190. [PMID: 33464484 DOI: 10.1007/s11096-021-01229-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/01/2021] [Indexed: 11/25/2022]
Abstract
Background Medication reconciliation prevents medication errors at care transition points. This process improves communication with general practitioners regarding the reasons for therapeutic changes, allowing those changes to be maintained after hospital discharge. Objective To investigate the impact of medication reconciliation in geriatrics on the sustainability of therapeutic optimization after hospital discharge. Setting This study was conducted in a geriatric unit in a University Hospital Centre in France. Method This was a retrospective study. For 6 months, all patients over 65 years who underwent the process of medication reconciliation performed by a clinical hospital pharmacist and a physician at admission and discharge, were included. A comparison between drug prescriptions at hospital discharge and the first prescription made outside the hospital was made to identify any differences. Main outcome measure The main outcome measures were the provision of the results of the medication reconciliation performed in the hospital to the relevant general practitioner, the subsequent acceptance of that information, the type of medication discrepancies one month after discharge and the therapeutic classes affected by the modifications. Results Among the 112 patients, medication reconciliation allowed us to identify and correct 87 unintentional discrepancies at admission (88% corrected) and 54 at discharge (92% corrected). Patients were discharged to homes or nursing homes (61%), geriatric rehabilitation units (38%) or psychiatric clinics (1%). A general practitioner wrote the first prescription renewal a mean of 36 ± 23 days after discharge, having been made aware of the medication reconciliation in only 24% of the cases (received and taken into account). The impact was a decrease in the number of patients with at least one discrepancy. Twenty-five percent of general practitioners who were aware about the medication reconciliation process accepted all therapeutic changes, while only 7% of those who were not informed did so (p = 0.02). The number of medication discrepancies observed was correlated with the number of medications for which prescriptions were renewed (p < 0.01). Conclusion Medication reconciliation involving therapeutic optimization and the justification of changes is essential to ensure the safety of the prescriptions written for patients. However, its impact after discharge is hampered by the fact that the results are often not received or taken into account by general practitioners. Taking medication reconciliation into account was associated with a significant increase in prescriptions that maintained therapeutic changes made in the hospital, confirming the positive impact of communication between care providers on therapeutic optimization.
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Affiliation(s)
- Maeva Montaleytang
- Pôle Pharmacie, Unité D'Expertise Pharmaceutique Et Recherche Biomédicale, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Florian Correard
- Pôle Pharmacie, Unité D'Expertise Pharmaceutique Et Recherche Biomédicale, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Charlotte Spiteri
- Service de Médecine Interne, Gériatrie Et Thérapeutique, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Philippe Boutier
- Pôle Pharmacie, Unité D'Expertise Pharmaceutique Et Recherche Biomédicale, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Stéphane Gayet
- Service de Médecine Interne, Gériatrie Et Thérapeutique, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Stéphane Honore
- Pôle Pharmacie, Unité D'Expertise Pharmaceutique Et Recherche Biomédicale, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Patrick Villani
- Service de Médecine Interne, Gériatrie Et Thérapeutique, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Aurélie Daumas
- Service de Médecine Interne, Gériatrie Et Thérapeutique, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France.
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Sécurisation du parcours de soins du sujet âgé : intérêt d’une offre variée d’activités pharmaceutiques ? ANNALES PHARMACEUTIQUES FRANÇAISES 2019; 77:222-231. [DOI: 10.1016/j.pharma.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 11/24/2022]
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Alix L, Dumay M, Cador-Rousseau B, Gilardi H, Hue B, Somme D, Jego P. Conciliation médicamenteuse avec remise d’une fiche de conciliation de sortie dans un service de Médecine Interne : évaluation de la perception des médecins généralistes. Rev Med Interne 2018; 39:393-399. [DOI: 10.1016/j.revmed.2018.03.378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 01/04/2023]
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