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首页> 外文期刊>Journal of Clinical Pharmacy and Therapeutics >Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model - Impact on all-cause emergency department revisits
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Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model - Impact on all-cause emergency department revisits

机译：作为Lund综合药物管理模型的一部分，系统地进行药物和解与审查的临床实施-对全因急诊科的影响

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What is known and objective: Interventions involving medication reconciliation and review by clinical pharmacists can reduce drug-related problems and improve therapeutic outcomes. The objective of this study was to examine the impact of routine admission medication reconciliation and inpatient medication review on emergency department (ED) revisits after discharge. Secondary outcomes included the combined rate of post-discharge hospital revisits or death. Methods: This prospective, controlled study included all patients hospitalized in three internal medicine wards in a university hospital, between 1 January 2006 and 31 May 2008. Medication reconciliation on admission and inpatient medication review, conducted by clinical pharmacists in a multiprofessional team, were implemented in these wards at different times during 2007 and 2008 (intervention periods). A discharge medication reconciliation was undertaken in all the study wards, during both control and intervention periods. Patients were included in the intervention group (n = 1216) if they attended a ward with medication reconciliation and review, whether they had received the intervention or not. Control patients (n = 2758) attended the wards before implementation of the intervention. Results and Discussion: No impact of medication reconciliation and reviews on ED revisits [hazard ratio (HR), 0·95; 95% confidence interval (CI), 0·86-1·04]or event-free survival (HR, 0·96; 95% CI, 0·88-1·04) was demonstrated. In the intervention group, 594 patients (48·8%) visited the ED, compared with 1416 (51·3%) control patients. In total, 716 intervention (58·9%) and 1688 (61·2%) control patients experienced any event (ED visit, hospitalization or death). Because the time to a subsequent ED visit was longer for the control as well as the intervention groups in 2007 than in 2006 (P < 0·05), we re-examined this cohort of patients; the proportion of patients revisiting the ED was similar in both groups in 2007 (P = 0·608). What is new and conclusion: Routine implementation of medication reconciliation and reviews on admission and during the hospital stay did not appear to have any impact on ED revisits, re-hospitalizations or mortality over 6-month follow-up.
机译：已知和客观的信息：涉及药物和解和临床药剂师审查的干预措施，可以减少药物相关的问题并改善治疗效果。这项研究的目的是检查出院后常规入院药物调和和住院药物复查对急诊科（ED）复诊的影响。次要结果包括出院后重访或死亡的总比率。方法：这项前瞻性，对照研究纳入了2006年1月1日至2008年5月31日期间在大学医院三个内科病房住院的所有患者。临床药师在一个多专业团队中对入院时的药物调和和住院药物复查进行了实施这些病房在2007年和2008年（干预期）的不同时间。在控制和干预期间，所有研究病房均进行了出院药物对账。如果患者参加了病房的药物对账和检查，是否接受了干预，则将其纳入干预组（n = 1216）。对照患者（n = 2758）在实施干预措施之前就诊了。结果与讨论：药物调和和评估对ED的再访均无影响[危险比（HR），0·95;证实了95％的置信区间（CI），0·86-1·04]或无事件生存率（HR，0·96; 95％CI，0·88-1·04）。在干预组中，有594例患者（48·8％）去急诊室就诊，而对照组为1416例（51·3％）。共有716例干预措施（58·9％）和1688例患者（61·2％）的对照患者经历了任何事件（急诊就诊，住院或死亡）。由于2007年对照组和干预组进行ED随访的时间比2006年要长（P <0·05），因此我们重新检查了该组患者。 2007年，两组患者再次访视ED的比例相似（P = 0·608）。新发现：结论：在6个月的随访中，常规的药物对账以及入院时和住院期间的复查似乎对ED复诊，再次住院或死亡率没有任何影响。

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