ApoMed, Michelangelostraat 62-2, 1077CG, Amsterdam, the Netherlands.
Department of Pharmacy, Sint Maartenskliniek, Ubbergen, the Netherlands.
BMC Health Serv Res. 2022 May 31;22(1):722. doi: 10.1186/s12913-022-08118-8.
Although medication reconciliation (MedRec) is mandated and effective in decreasing preventable medication errors during transition of care, hospitals implement MedRec differently.
Quantitatively compare the number and type of MedRec interventions between hospitals upon admission and discharge, followed by a qualitative analysis on potential reasons for differences.
This explanatory retrospective mixed-method study consisted of a quantitative and a qualitative part. Patients from six hospitals and six different wards i.e. orthopaedics, surgery, pulmonary diseases, internal medicine, cardiology and gastroenterology were included. At these wards, MedRec was implemented both on hospital admission and discharge. The number of pharmacy interventions was collected and classified in two subcategories. First, the number of interventions to resolve unintended discrepancies (elimination of differences between listed medication and the patient's actual medication use). And second, the number of medication optimizations (optimization of pharmacotherapy e.g. eliminating double medication). Based on these quantitative results and interviews, a focus group was performed to give insight in local MedRec processes to address differences in context between hospitals. Descriptive analysis (quantitative) and content analysis (qualitative) was used.
On admission 765 (85%) patients from six hospitals, received MedRec by trained nurses, pharmacy technicians, pharmaceutical consultants or pharmacists. Of those, 36-95% (mean per patient 2.2 (SD ± 2.4)) had at least one discrepancy. Upon discharge, these numbers were among 632 (70%) of patients, 5-28% (mean per patient 0.7 (SD 1.2)). Optimizations in pharmacotherapy were implemented for 2% (0.4-3.7 interventions per patient upon admission) to 95% (0.1-1.7 interventions per patient upon discharge) of patients. The main themes explaining differences in numbers of interventions were patient-mix, the type of healthcare professionals involved, where and when patient interviews for MedRec were performed and finally, embedding and extent of medication optimization.
Hospitals differed greatly in the number of interventions performed during MedRec. Differences in execution of MedRec and local context determines the number of interventions. This study can support hospitals who want to optimize MedRec processes.
尽管药物重整（MedRec）在降低医疗保健过渡期间可预防的药物错误方面是强制性和有效的，但医院实施 MedRec 的方式却有所不同。
定量比较入院和出院时医院之间的 MedRec 干预措施的数量和类型，然后对差异的潜在原因进行定性分析。
本研究采用解释性回顾性混合方法，包括定量和定性两部分。来自六家医院的六个不同病房的患者被纳入研究，这些病房包括骨科、外科、肺部疾病、内科、心脏病学和胃肠病学。在这些病房，在入院和出院时都实施了 MedRec。收集并分类了药房干预措施的数量，并分为两个亚类。首先，干预措施的数量旨在解决未预期的差异（消除列出的药物与患者实际用药之间的差异）。其次，药物优化的数量（例如消除双重用药的药物治疗优化）。基于这些定量结果和访谈，进行了焦点小组讨论，以深入了解医院之间背景差异的本地 MedRec 流程。采用描述性分析（定量）和内容分析（定性）。
在六家医院的 765 名（85%）患者接受了经过培训的护士、药房技术员、医药顾问或药剂师的入院 MedRec。其中，36-95%（平均每个患者 2.2（SD ± 2.4））至少有一个差异。在出院时，这些数字是在 632 名（70%）患者中，5-28%（平均每个患者 0.7（SD 1.2））。药物治疗优化的实施比例为 2%（入院时每个患者 0.4-3.7 次干预）至 95%（出院时每个患者 0.1-1.7 次干预）。解释干预措施数量差异的主要主题是患者组合、参与的医疗保健专业人员类型、进行患者 MedRec 访谈的地点和时间，以及药物优化的嵌入和程度。
医院在 MedRec 期间进行的干预措施数量存在很大差异。MedRec 的执行差异和当地情况决定了干预措施的数量。本研究可以为希望优化 MedRec 流程的医院提供支持。
