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Observational Study
. 2022 Jul 13;22(1):576.
doi: 10.1186/s12877-022-03192-3.

Pharmacist-led medication reconciliation at patient discharge: a tool to reduce healthcare utilization? an observational study in patients 65 years or older

Emma Bajeux  1 , Lilian Alix  2 , Lucie Cornée  3 , Camille Barbazan  4 , Marion Mercerolle  4 , Jennifer Howlett  4 , Vincent Cruveilhier  5 , Charlotte Liné-Iehl  6 , Bérangère Cador  2 , Patrick Jego  2 , Vincent Gicquel  4 , François-Xavier Schweyer  7 , Vanessa Marie  8 , Stéphanie Hamonic  9 , Jean-Michel Josselin  10 , Dominique Somme  11 , Benoit Hue  4
Affiliations
Observational Study

Pharmacist-led medication reconciliation at patient discharge: a tool to reduce healthcare utilization? an observational study in patients 65 years or older

Emma Bajeux et al. BMC Geriatr. .

Abstract

Background: Older patients often experience adverse drug events (ADEs) after discharge that may lead to unplanned readmission. Medication Reconciliation (MR) reduces medication errors that lead to ADEs, but results on healthcare utilization are still controversial. This study aimed to assess the effect of MR at discharge (MRd) provided to patients aged over 65 on their unplanned rehospitalization within 30 days and on both patients' experience of discharge and their knowledge of their medication.

Methods: An observational multicenter prospective study was conducted in 5 hospitals in Brittany, France.

Results: Patients who received both MR on admission (MRa) and MRd did not have significantly fewer deaths, unplanned rehospitalizations and/or emergency visits related to ADEs (OR = 1.6 [0.7 to 3.6]) or whatever the cause (p = 0.960) 30 days after discharge than patients receiving MRa alone. However, patients receiving both MRa and MRd were more likely to feel that their discharge from the hospital was well organized (p = 0.003) and reported more frequently that their community pharmacist received information about their hospital stay (p = 0.036).

Conclusions: This study found no effect of MRd on healthcare utilization 30 days after discharge in patients over 65, but the process improved patients' experiences of care continuity. Further studies are needed to better understand this positive impact on their drug care pathway in order to improve patients' ownership of their drugs, which is still insufficient. Improving both the interview step between pharmacist and patient before discharge and the transmission of information from the hospital to primary care professionals is needed to enhance MR effectiveness.

Trial registration: NCT04018781 July 15, 2019.

Keywords: Adverse Drug Event; Discharge; Experience; Medication Reconciliation; Older people.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a Description of the steps in the Medication Reconciliation procedure on admission. b Description of the steps in the Medication Reconciliation procedure on discharge
Fig. 2
Fig. 2
Flowchart. MRa Medication Reconciliation on admission, MRd Medication Reconciliation on discharge
See this image and copyright information in PMC

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