To analyse the impact of a medication reconciliation toolkit (OCM) which details all the treatment at the admission, intra-hospital therapeutic adjustment and their justifications, on the transmission and quality of extra-hospital follow-up of prescribing recommendations.
The OCM was fulfilled with the prescriptions of patient aged ≥75 years admitted to a geriatric short-stay unit and sent to general practitioners (GPs) upon discharge. Drug discrepancies (DD) and exposure to polypharmacy after intra-hospital medication conciliation and the ambulatory repeat prescribing (1 month after discharge) were measured. GPs' satisfaction was investigated.
The medication list of 173 patients (1242 molecules; median 8 molecules/day) were reconciled, optimized, and transmitted using the OCM to the 89 GPs of the 103 patients who were returned home. Intra-hospital conciliation identified 779 DD (4.6 ± 2.3) of which 39.0% were missed treatment additions. After renewal of the discharge order, only 1.6 ± 1.6 DD were measured. Between admission, discharge, and repeat prescribing, exposure to polypharmacy was reduced from 83.2 to 74.6 and 67.7% (p<0.05). Despite a 31.5% response rate to the mail questionnaire, 79.3% of physicians thought the OCM facilitated continuity of care and 75.5% wanted it generalized.
This study shows that the OCM is a useful tool and of interest for documenting the process of intra-hospital therapeutic optimization and in the rapid transmission and the follow-up of recommendations by partners in the community.