Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety

Pharmaceuticals

Elizabeth E. Powell¹  Kelly L. Hayward¹  Katharine M. Irvine¹  Patricia C. Valery¹  Leigh U. Horsfall¹  Preya J. Patel¹  Penny L. Wright²  Caroline J. Tallis²  Katherine A. Stuart²  Neil Cottrell³  Catherine Li⁴  Jennifer H. Martin⁵  Michael David⁵ 

[1] Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, 37 Kent Street, Woolloongabba, Brisbane, QLD 4102, Australia;Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia;Faculty of Health and Behavioral Sciences, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia;Pharmacy Department, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia;School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia;

关键词: clinical pharmacist;    medication complexity;    medication reconciliation;    medication related problems;    medication safety;   

DOI  :  10.3390/ph14121207

来源: DOAJ

【 摘 要 】

Discrepancies between the medicines consumed by patients and those documented in the medical record can affect medication safety. We aimed to characterize medication discrepancies and medication regimen complexity over time in a cohort of outpatients with decompensated cirrhosis, and evaluate the impact of pharmacist-led intervention on discrepancies and patient outcomes. In a randomized-controlled trial (n = 57 intervention and n = 57 usual care participants), medication reconciliation and patient-oriented education delivered over a six-month period was associated with a 45% reduction in the incidence rate of ‘high’ risk discrepancies (IRR = 0.55, 95%CI = 0.31–0.96) compared to usual care. For each additional ‘high’ risk discrepancy at baseline, the odds of having ≥ 1 unplanned medication-related admission during a 12-month follow-up period increased by 25% (adj-OR = 1.25, 95%CI = 0.97–1.63) independently of the Child–Pugh score and a history of variceal bleeding. Among participants with complete follow-up, intervention patients were 3-fold less likely to have an unplanned medication-related admission (adj-OR = 0.27, 95%CI = 0.07–0.97) compared to usual care. There was no association between medication discrepancies and mortality. Medication regimen complexity, frequent changes to the regimen and hepatic encephalopathy were associated with discrepancies. Medication reconciliation may improve medication safety by facilitating communication between patients and clinicians about ‘current’ therapies and identifying potentially inappropriate medicines that may lead to harm.

【 授权许可】

Unknown