Department of Internal Medicine, Ospedale Regionale di Mendrisio, Ente Ospedaliero Cantonale, Mendrisio, Ticino, Switzerland.
Hospital Pharmacy Service, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.
BMJ Open. 2019 May 27;9(5):e026259. doi: 10.1136/bmjopen-2018-026259.
Medication reconciliation (MedRec) is a relevant safety procedure in medication management at transitions of care. The aim of this study was to evaluate the impact of MedRec, including a (BPMH) compared with a standard medication history in patients admitted to an internal medicine ward.
Prospective interventional study. Data were analysed using descriptive statistics followed by univariate and multivariate Poisson regression models and a zero-inflated Poisson regression model.
Internal medicine ward in a secondary care hospital in Southern Switzerland.
The first 100 consecutive patients admitted in an internal medicine ward.
Medication discrepancies between the medication list obtained by the physician and that obtained by a pharmacist according to a systematic approach (BPMH) were collected, quantified and assessed by an expert panel that assigned a severity score. The same procedure was applied to discrepancies regarding allergies. Predicting factors for medication discrepancies were identified.
The median of medications per patient was 8 after standard medication history and 11 after BPMH. Total admission discrepancies were 524 (5.24 discrepancies per patient) with at least 1 discrepancy per patient. For 47 patients, at least one discrepancy was classified as clinically relevant. Discrepancies were classified as significant and serious in 19% and 2% of cases, respectively. Furthermore, 67% of the discrepancies were detected during the interview conducted by the pharmacist with the patients and/or their caregivers. The number of drugs used and the autonomous management of home therapy were associated with an increased number of clinically relevant discrepancies in a multivariable Poisson regression model.
Even in an advanced healthcare system, a standardised MedRec process including a BPMH represents an important strategy that may contribute to avoid a notable number of clinically relevant discrepancies and potential adverse drug events.
在医疗保健过渡期，药物重整（MedRec）是药物管理的一项重要安全措施。本研究旨在评估 MedRec 的效果，包括与标准药物病史相比，在入住内科病房的患者中的作用。
前瞻性干预研究。使用描述性统计分析数据，然后使用单变量和多变量泊松回归模型以及零膨胀泊松回归模型进行分析。
瑞士南部二级保健医院的内科病房。
内科病房的前 100 名连续入院患者。
根据系统方法（BPMH），收集、量化和评估了医生获得的药物清单与药剂师获得的药物清单之间的药物差异，并由专家小组进行评估，分配严重程度评分。同样的程序也适用于过敏差异。确定了导致药物差异的预测因素。
标准药物病史后每位患者的药物中位数为 8，BPMH 后为 11。总入院差异为 524 个（每个患者 5.24 个差异），每个患者至少有一个差异。对于 47 名患者，至少有一个差异被归类为临床相关。在 19%和 2%的病例中，差异分别被归类为显著和严重。此外，67%的差异是在药剂师与患者及其照顾者进行访谈时发现的。在多变量泊松回归模型中，使用的药物数量和家庭治疗的自主管理与更多的临床相关差异相关。
即使在先进的医疗保健系统中，包括 BPMH 的标准化 MedRec 流程也是一种重要策略，可有助于避免显著数量的临床相关差异和潜在的药物不良事件。
