Integrated Medicines Management Model Research Articles

The Medicines Optimisation Innovation Centre: a dedicated centre driving innovation in medicines optimisation-impact and sustainability

BackgroundSub-optimal medicines use is a challenge globally, contributing to poorer health outcomes, inefficiencies and waste. The Medicines Optimisation Innovation Centre (MOIC) was established in Northern Ireland by the Department of Health (DH) in 2015 to support implementation of the Medicines Optimisation Quality Framework.AimTo demonstrate how MOIC informs policy and provides support to commissioners to improve population health and wellbeing.SettingMOIC is a regional centre with multidisciplinary and multi-sector clinical expertise across Health and Social Care and patient representation.DevelopmentCore funded by DH, MOIC has a robust governance structure and oversight programme board. An annual business plan is agreed with DH. Rigorous processes have been developed for project adoption and working collaboratively with industry.ImplementationMOIC has established partnerships with academia, industry, healthcare and representative organisations across Europe, participating in research and development projects and testing integrated technology solutions. A hosting programme has been established and evaluation and dissemination strategies have been developed.EvaluationMOIC has established numerous agreements, partnered in three large EU projects and strengthened networks globally with extensive publications and conference presentations. Informing pathway redesign, sustainability and COVID response, MOIC has also assisted in the development of clinical pharmacy services and antimicrobial stewardship in Europe and Africa. Northern Ireland has been recognised as a 4-star European Active and Healthy Ageing Reference Site and the Integrated Medicines Management model as an example of best practice in Central and Eastern Europe.ConclusionMOIC has demonstrated considerable success and sustainability and is applicable to health systems globally.

Effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial

ObjectiveTo investigate the effect of pharmacist-led medicines management in multimorbid, hospitalised patients on long-term hospital readmissions and survival.DesignParallel-group, randomised controlled trial.SettingRecruitment from an internal medicine hospital ward in Oslo, Norway....

Prospective observational study of medication reviews in internal medicine wards: evaluation of drug-related problems

BackgroundThe Lund Integrated Medicines Management model offers a systematic approach for individualising and optimising patient drug treatment. Clinical, economical and humanistic outcomes have been shown as well as results from...

Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (IMMENSE study): study protocol for a randomised controlled trial

IntroductionDrug-related problems (DRPs) are common in the elderly, leading to suboptimal therapy, hospitalisations and increased mortality. The integrated medicines management (IMM) model is a multifactorial interdisciplinary methodology aiming to optimise...

Results from a project to develop systematic patient focused clinical pharmacy services. The Lund Integrated Medicines Management model

As people get older, polypharmacy increases and there is an increased risk of adverse drug events, drug interactions, low medication adherence, increasing economic burden, hospital admissions and even drug-related deaths.1...

CPC-051 Evaluation of Implementation of Clinical Pharmacy Services in Central Norway

BackgroundCentral Norway Pharmaceutical Trust consists of six hospital pharmacies covering eight hospitals. In partnership with a research group at the University of Lund and the Lund Hospital Pharmacy, Sweden, we...

GRP-040 Clinical Significance of Recommendations Made by Pharmacists About Drug-Related Problems (DRP)

BackgroundThe Ministry of Health in Norway has requested an expanded contribution from clinical pharmacy in healthcare delivery because of serious medication-related issues. Examples of this are participation in treatment teams...

CPC-114 Prevalence and Management of Drug-Related Problems in an Intensive Care Unit

BackgroundPatients admitted to intensive care units (ICUs) are at higher risk than other patients of having problems, injuries and adverse drug reactions (ADRs) associated with their drug treatment.Purpose To identify...

Health economic evaluation of the Lund Integrated Medicines Management Model (LIMM) in elderly patients admitted to hospital

ObjectiveTo evaluate the cost effectiveness of a multidisciplinary team including a pharmacist for systematic medication review and reconciliation from admission to discharge at hospital among elderly patients (the Lund Integrated...

Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model - impact on all-cause emergency department revisits

Interventions involving medication reconciliation and review by clinical pharmacists can reduce drug-related problems and improve therapeutic outcomes. The objective of this study was to examine the impact of routine admission medication reconciliation and inpatient medication review on emergency department (ED) revisits after discharge. Secondary outcomes included the combined rate of post-discharge hospital revisits or death. This prospective, controlled study included all patients hospitalized in three internal medicine wards in a university hospital, between 1 January 2006 and 31 May 2008. Medication reconciliation on admission and inpatient medication review, conducted by clinical pharmacists in a multiprofessional team, were implemented in these wards at different times during 2007 and 2008 (intervention periods). A discharge medication reconciliation was undertaken in all the study wards, during both control and intervention periods. Patients were included in the intervention group (n = 1216) if they attended a ward with medication reconciliation and review, whether they had received the intervention or not. Control patients (n = 2758) attended the wards before implementation of the intervention. No impact of medication reconciliation and reviews on ED revisits [hazard ratio (HR), 0.95; 95% confidence interval (CI), 0.86-1.04]or event-free survival (HR, 0.96; 95% CI, 0.88-1.04) was demonstrated. In the intervention group, 594 patients (48.8%) visited the ED, compared with 1416 (51.3%) control patients. In total, 716 intervention (58.9%) and 1688 (61.2%) control patients experienced any event (ED visit, hospitalization or death). Because the time to a subsequent ED visit was longer for the control as well as the intervention groups in 2007 than in 2006 (P < 0.05), we re-examined this cohort of patients; the proportion of patients revisiting the ED was similar in both groups in 2007 (P = 0.608). Routine implementation of medication reconciliation and reviews on admission and during the hospital stay did not appear to have any impact on ED revisits, re-hospitalizations or mortality over 6-month follow-up.

The lund integrated medicines management model, health outcomes and processes development.

BackgroundThe effects from medication use in clinical trials are hard to achieve in standard care. Instead of health benefits for the patient there is risk of errors and negative consequences...

Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

To examine the impact of systematic medication reconciliations upon hospital admission and of a medication review while in hospital on the number of inappropriate medications and unscheduled drug-related hospital revisits in elderly patients. This was a prospective, controlled study in 210 patients, aged 65years or older, who were admitted to one of three internal medicine wards at a University Hospital in Sweden. Intervention patients received the complete Lund Integrated Medicines Management model (medication reconciliation upon admission and discharge, and medication review and monitoring) provided by a multi-professional team, including a clinical pharmacist. Control patients received standard care and medication reconciliation upon discharge. Blinded reviewers evaluated the appropriateness of the prescribing (using the Medication Appropriateness Index) on admission and discharge, and assessed the probability that a drug-related problem was the reason for any patient readmitted to hospital or visiting the emergency department within 3 months of discharge (using World Health Organisation causality criteria). There was a greater decrease in the number of inappropriate drugs in the intervention group than in the control group for both the intention-to-treat population {51% [95% confidence interval (CI) 43-58%] vs. 39% (95% CI 30-48%); p = 0.0446} and the per-protocol population [60% (95% CI 51-67%) vs. 44% (95% CI 34-52%); p = 0.0106)]. There were six revisits to hospital in the intervention group which were judged as 'possibly, probably or certainly drug-related', compared with 12 in the control group (p = 0.0469). In this study, medication reconciliation and review provided by a clinical pharmacist in a multi-professional team significantly reduced the number of inappropriate drugs and unscheduled drug-related hospital revisits among elderly patients.