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Impact of a multidisciplinary medication reconciliation program on clinical outcomes: A pre-post intervention study
A B Guisado-Gil1, N Ramírez-Duque2, B Barón-Franco2
1Unidad de Gestión Clínica Farmacia. Hospital Universitario Virgen del Rocío, Sevilla, Spain; Departamento de Farmacología. Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain.
Background:
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.
Objective:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
Insights
A multidisciplinary medication reconciliation program improved outcomes for high-risk surgery patients, particularly those over 75 or with cardiovascular disease. The program enhanced blood pressure and insulin management, though overall length of stay did not significantly change.
Area of Science:
- Medical Sciences
- Clinical Pharmacy
- Surgical Oncology
Background:
- Medication reconciliation (MR) is studied for reducing discrepancies, but evidence for patient outcomes is limited.
- Recent reviews highlight the need for further research on MR's impact on patient-related outcomes and healthcare utilization.
Purpose of the Study:
- To assess a multidisciplinary medication reconciliation program's effect on clinical outcomes.
- Focus on patients with colorectal cancer and other chronic conditions undergoing elective surgery.
Main Methods:
- A pre-post study design was employed.
- Included adult patients undergoing elective colorectal cancer surgery with at least one high-risk criterion.
- A multidisciplinary team (internists, pharmacists, surgeons) managed MR from pre-admission to discharge, tracking length of stay, mortality, and complications.
Main Results:
- 308 patients were enrolled; preventable surgery cancellations were minimal (1 patient).
- While overall length of stay (LOS) showed no significant change (13 ± 12 vs. 11 ± 5 days), a significant benefit was seen in patients >75 years old (p=0.043) and those with cardiovascular disease (p=0.038).
- Improved management of preoperative blood pressure in hypertensive patients (p=0.004) and insulin reconciliation in diabetic patients (p=0.003) were noted.
Conclusions:
- The multidisciplinary MR program did not significantly alter the overall mean length of stay.
- A significant positive impact on LOS was observed in vulnerable subgroups: patients over 75 and those with cardiovascular disease, showing a 5-day reduction in mean LOS.
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