Effects of a pharmacy-driven medication history program on patient outcomes

Area of Science:

• Health Services Research
• Clinical Pharmacy
• Patient Safety

Background:

• Accurate medication histories are crucial for effective medication reconciliation.
• Inaccurate or incomplete medication histories are common upon hospital admission.
• This study investigates the impact of a pharmacy-led initiative to improve medication history accuracy.

Purpose of the Study:

• To evaluate the association between a pharmacy-driven medication history initiative and clinical outcomes.
• To assess the effect of this intervention on patients admitted to a general medicine service.
• To determine if pharmacy-driven histories improve medication reconciliation processes.

Main Methods:

• Retrospective propensity score analysis comparing patients with and without pharmacy-driven histories.
• Controlled for 52 patient baseline characteristics (demographic, operational, clinical).
• Evaluated hospital length of stay, 7-day/30-day readmissions, and in-hospital mortality.

Main Results:

• Pharmacy-driven histories were associated with a shorter hospital length of stay (5.88 vs 6.53 days; P=0.0002).
• In-hospital mortality rates were lower in patients receiving pharmacy-driven histories (2.34% vs 3.72%; P=0.001).
• No significant difference in 7-day or 30-day all-cause readmission rates was observed.

Conclusions:

• Pharmacy-driven medication histories effectively reduced length of stay and in-hospital mortality.
• The intervention did not impact 7-day and 30-day all-cause readmission rates.
• Further validation through multisite randomized controlled trials is recommended.