Analysis of the impact of a medication reconciliation tool on the hospital-community interface.

Abstract

To analyse the impact of a medication reconciliation tool (MRT), which contains information on all the treatments a patient is receiving upon admission as well as intra-hospital therapeutic adjustments and the rationale behind them, on the transmission and quality of the follow-up of prescribing recommendations outside the hospital setting. The MRT involved the prescriptions of patients who were aged 75 and over, who were admitted to a geriatric short-stay unit, and who were referred to a general practitioner (GP) upon discharge. Drug discrepancies (DD) and polypharmacy after an intra-hospital medication reconciliation and at the time of renewing the out-patient prescription (one month after discharge) were measured. Satisfaction among GPs was investigated. The medication lists of 173 patients (1242 drugs; median eight drugs/day) were reconciled, optimised, and communicated using the MRT to the 89 GPs of the 103 patients who returned home. Intra-hospital reconciliation identified 779 DDs (4.6 ± 2.3), of which 39.0% were additions to treatment that had been overlooked. After the discharge prescription was renewed, only 1.6 ± 1.6 DDs were measured. Between admission, discharge, and repeat prescription, polypharmacy was reduced from 83.2% to 74.6% and 67.7% (p < 0.05). Despite a 31.5% response rate to the postal questionnaire, 79.3% of physicians thought the MRT facilitated continuity of care and 75.5% wanted it to be rolled-out more widely. This study shows that the MRT is a useful tool and of interest for documenting the process of intra-hospital therapeutic optimisation and with regard to the rapid transmission and follow-up of recommendations by partners in the community.