Unidad de Gestión Clínica Farmacia. Hospital Universitario Virgen del Rocío, Sevilla, Spain; Departamento de Farmacología. Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain.
Unidad de Gestión Clínica Medicina Interna. Hospital Universitario Virgen del Rocío, Sevilla, Spain.
Res Social Adm Pharm. 2021 Jul;17(7):1306-1312. doi: 10.1016/j.sapharm.2020.09.018. Epub 2020 Oct 1.
Previous studies have evaluated the effects of medication reconciliation (MR) and suggest that it is effective in decreasing medication discrepancies. Nevertheless, a recent overview of systematic reviews concluded that there is no clear evidence in favor of MR in patient-related outcomes and healthcare utilization, and further research about it is needed.
To evaluate the impact of a multidisciplinary MR program on clinical outcomes in patients with colorectal cancer presenting other chronic diseases, undergoing elective colorectal surgery.
We performed a pre-post study. Adult patients scheduled for elective colorectal cancer surgery were included if they presented at least one "high-risk" criteria. The MR program was developed by internists, pharmacists and surgeons, and ended with the obtention of the patient's pre-admission medication list and follow-up care until discharge. The primary outcome was the length of stay (LOS). Secondly, we evaluated mortality, preventable surgery cancellations and risk factors for complications.
Three hundred and eight patients were enrolled. Only one patient in the pre-intervention group suffered a preventable surgery cancellation (p = 0.317). The mean LOS was 13 ± 12 vs. 11 ± 5 days in the pre-intervention and the intervention cohort, respectively (p = 0.435). A difference in favor of the intervention group in patients with cardiovascular disease (p = 0.038) and those >75 years old (p = 0.043) was observed. No difference was detected in the mortality rate (p = 0.999) neither most of the indicators of risk factors for complications. However, the management of preoperative systolic blood pressure of hypertensive patients (p = 0.004) and insulin reconciliation in patients with treated diabetes (p = 0.003) were statistically better in the intervention group.
No statistically significant change was observed in the mean global LOS. A statistically significant positive effect on LOS was observed in vulnerable populations: patients >75 years old and those with cardiovascular disease, who presented a 5-day reduction in the mean LOS.
先前的研究已经评估了药物重整（MR）的效果，并表明它在减少药物差异方面是有效的。然而，最近对系统综述的综述得出的结论是，没有明确的证据表明 MR 有利于患者相关结局和医疗保健的利用，因此需要进一步的研究。
评估多学科 MR 计划对患有其他慢性病、接受择期结直肠手术的结直肠癌患者的临床结局的影响。
我们进行了一项前后研究。如果择期结直肠癌手术的成年患者符合至少一个“高危”标准，则将其纳入研究。MR 计划由内科医生、药剂师和外科医生制定，并以获得患者的入院前用药清单和随访护理直至出院结束。主要结局是住院时间（LOS）。其次，我们评估了死亡率、可预防手术取消和并发症的危险因素。
共纳入 308 例患者。干预前组仅有 1 例患者发生可预防的手术取消（p=0.317）。干预前组和干预组的平均 LOS 分别为 13±12 天和 11±5 天（p=0.435）。在心血管疾病患者（p=0.038）和>75 岁的患者（p=0.043）中观察到干预组有优势。两组之间死亡率无差异（p=0.999），并发症危险因素的大多数指标也无差异。然而，在高血压患者的术前收缩压管理（p=0.004）和治疗糖尿病患者的胰岛素重整（p=0.003）方面，干预组的结果明显更好。
在全球 LOS 均值方面未观察到统计学显著变化。在脆弱人群中观察到 LOS 统计学显著的积极影响：>75 岁和患有心血管疾病的患者，平均 LOS 减少了 5 天。
