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Targeting of under-75 years for the optimization of medication reconciliation with an approach based on medication
Justine Perino1, Amandine Gouverneur2, Fabrice Bonnet3
1CHU de Bordeaux, service pharmacie à usage intérieur, secteur pharmacie clinique, pôle des produits de santé, 33604 Pessac, France.
Insights
Prioritizing medication reconciliation (MR) by identifying high-risk medications in non-elderly patients upon admission is effective. This strategy led to more treatment changes, improving patient safety in internal medicine.
Area of Science:
- Internal Medicine
- Pharmacovigilance
- Patient Safety
Background:
- Medication reconciliation (MR) prioritization in younger patients is under-evaluated.
- Identifying high-risk medications at admission may offer a novel prioritization strategy for non-elderly patients.
Purpose of the Study:
- To assess the effectiveness of a medication reconciliation prioritization strategy in non-elderly patients.
- To determine if identifying high-risk medications at admission can guide MR prioritization.
Main Methods:
- Prospective study in an internal medicine unit (July-September 2017).
- Included patients aged 16-74 years with ≥2 long-term treatments at admission.
- High-risk medications defined by pharmacovigilance data (antithrombotics, analgesics, antipsychotics, cardiac therapies).
Main Results:
- 92 participants: 46 with high-risk medications (HRM) and 46 without.
- MR resulted in treatment changes for 37% of patients with HRM vs. 8.7% without (P=0.001).
- Clinically major MR-induced treatment changes were more frequent in the HRM group (43.5%) than the non-HRM group (31.6%).
Conclusions:
- Targeting high-risk medications at admission is an efficient strategy for prioritizing MR in non-elderly internal medicine patients.
- This approach can help optimize medication management and improve patient safety.
Purpose:
To date, how medication reconciliation (MR) could be prioritized in younger patients remains poorly evaluated. This study aimed at assessing whether a MR prioritization strategy based on the identification of high-risk medication at patients' admission treatment could be of interest in non-elderly patients.
Method:
This prospective study was conducted between July and September 2017 in an internal medicine unit at Bordeaux teaching hospital. All patients aged 16 to 74 years and receiving at least two long-term treatments at admission were considered eligible. High-risk medications were defined on the basis of a pharmacovigilance study, which identified the drugs most involved in serious adverse effects reported in the Nouvelle-Aquitaine region in non-elderly adults. They included antithrombotics, analgesics, antipsychotics and cardiac therapies. MR-induced treatment changes were compared according to the existence of high-risk medications at admission in study participants.
Results:
Among the 92 study participants, 46 presented with high-risk medications at admission (median age 66 years, IQR 58-70) and 46 without such (median age 54 years, IQR 47-64). High risk-medications (HRM) existing at admission were antithrombotics (52.2%) and antipsychotics (22.4%). MR resulted in treatment changes in 37% of patients admitted with at-risk medications vs. 8.7% of those admitted without such (P=0.001). Overall, the mean number of treatment changes performed after MR was of 1 (95%CI 0.4-1.6) in patients with high-risk medication at admission and of 0.2 (95%CI 0-0.4) in patients without such. MR-induced treatment changes assessed as clinically major at least once by pharmacists or clinicians was greater in HRM group (43.5%) than in non-HRM group (31.6%). However, the consistency was low between clinicians and pharmacists, especially to distinguish the clinical importance of significant and minor interventions.
Conclusion:
Targeting high-risk medications at admission appeared efficient for the prioritization of MR in non-elderly patients hospitalised in internal medicine.
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