One Size Does Not Fit All: Medication Reconciliation and Review at the Hospital at Home

Area of Science:

• Geriatrics
• Pharmacology
• Health Services Research

Background:

• Medication errors are a significant cause of patient morbidity and mortality.
• Medication reconciliation (MRec) and medication review (MRev) are vital for optimizing medication effectiveness and safety.
• These processes are particularly critical during patient discharge and in home-based care settings.

Purpose of the Study:

• To evaluate and describe the implementation of MRec and MRev at a Hospital at Home program.
• To assess the role of these processes in medication deprescribing for patients receiving home-based hospital care.

Main Methods:

• Retrospective cohort study of adult patients admitted to Hospital at Home (Nov 2022 - Apr 2023).
• MRec and MRev were conducted during hospitalization, with communication to patients at discharge.
• Analysis included patient demographics, polypharmacy status, medication discrepancies, and deprescribing outcomes.

Main Results:

• The study included 125 patients (average age 67.6 years), with 50% experiencing polypharmacy.
• Medication discrepancies were identified in 43.2% of patients.
• Deprescribing was performed in approximately one-third of patients, with significantly older patients (mean age 76.1 years) being more likely to be deprescribed (p=0.044).

Conclusions:

• Hospital at Home provides a valuable setting for MRec and MRev, including deprescribing.
• Identifying high-risk patients for adverse drug events is crucial for minimizing treatment-related harms.
• Further research is needed to optimize these processes within Hospital at Home models.