Service de gériatrie, Centre hospitalier universitaire de Rouen, Rouen, France
Service de gériatrie, Centre Hospitalier de Dieppe, Dieppe, France
Service de gériatrie et réadaptation gériatrique, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Suisse
Clinique de Genolier, Genolier, Suisse
Objective: 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. Methods: 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. Results: 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. Conclusion: 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.