Department of Hospital Pharmacy, Erasmus Medical Centre, Rotterdam, the Netherlands.
J Am Geriatr Soc. 2013 Aug;61(8):1262-8. doi: 10.1111/jgs.12380. Epub 2013 Jul 19.
To investigate the effect of pharmacy-based medication reconciliation on the frequency of unintentional medication discrepancies in acutely admitted individuals aged 65 and older.
Multicenter intervention study with pre-post design.
Twelve Dutch hospitals.
One thousand five hundred forty-three individuals aged 65 and older with an acute hospital admission through the emergency department.
The intervention consisted of the Best Possible Medication History (BPMH), based on combining information from the community pharmacy record, the information provided by a structured interview with participants about their medication use, and medication containers. In nine hospitals, pharmacy technicians obtained the BPMH, and in three hospitals, a mixed model was used (physicians or pharmacy technicians obtained the BPMH). Primary outcome measure was the proportion of participants with one or more unintentional medication discrepancies. The primary outcome measure was stratified according to type of intervention (pharmacy based vs mixed model).
The proportion of participants with one or more unintentional medication discrepancies was reduced from 62% to 32% [odds ratio (OR) = 0.29, 95% confidence interval (CI) = 0.23-0.37]. These results remained statistically significant after adjustment for type of department and hospital (OR = 0.20, 95% CI = 0.15-0.26), and this effect remained stable for 6 months. Stratified analysis showed that no effect from the intervention was evident in the three hospitals with a mixed-model intervention, in contrast to the hospitals with a pharmacy-based intervention. The medication discrepancy types "omission" and "dosage or strength" occurred most frequently and were the main types that the intervention influenced.
Pharmacy-based medication reconciliation leads to a substantial reduction in medication discrepancies in acutely admitted elderly adults.
调查基于药剂师的用药核对对 65 岁及以上急性入院个体无意中药物差异的频率的影响。
采用前后对照的多中心干预研究。
荷兰的 12 家医院。
1543 名年龄在 65 岁及以上的急性入院个体，他们通过急诊科入院。
干预措施包括基于最佳可能药物史（BPMH）的方法，该方法结合了社区药房记录的信息、参与者关于其用药情况的结构化访谈提供的信息和药物容器的信息。在 9 家医院，药剂师获取 BPMH，而在 3 家医院，则采用混合模式（医生或药剂师获取 BPMH）。主要结局指标是存在一个或多个无意中药物差异的参与者比例。主要结局指标根据干预类型（基于药剂师的干预与混合模式）进行分层。
存在一个或多个无意中药物差异的参与者比例从 62%降至 32%[比值比（OR）=0.29，95%置信区间（CI）=0.23-0.37]。在调整了科室和医院类型后，这些结果仍然具有统计学意义（OR=0.20，95%CI=0.15-0.26），并且这种效果在 6 个月内保持稳定。分层分析表明，在采用混合模式干预的 3 家医院中，干预没有效果，而在采用基于药剂师的干预的医院中则有效果。药物差异类型“遗漏”和“剂量或强度”最常见，是干预影响的主要类型。
基于药剂师的用药核对可显著减少急性入院老年患者的药物差异。
