Effectiveness of Pre-Consultation Medication Reconciliation Service in Reducing Unintentional Medication Discrepancies During Transition of Care From Hospital Discharge to Primary Care Setting

Study Overview
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Brief Summary
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This study evaluates the the effectiveness of pre-consultation Medication Reconciliation Service in reducing unintentional medication discrepancies among patients who discharged from hospital to primary care.

Detailed Description
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Medication discrepancies during care transition were common. Many factors contribute to the risk of medication discrepancies. Despite medication reconciliation service being practiced in the hospital setting, there was limited knowledge on its effectiveness in the primary care setting. This study aims to evaluate the effectiveness of a pre-consultation medication reconciliation service in reducing medication discrepancies in patients who transit from hospital to primary care. Adult patients who made their first visit to the polyclinics following a recent hospital discharge and were prescribed with 5 or more chronic medications were randomised to 2 groups. Pre-consultation medication reconciliation by a pharmacist was carried out for the intervention group. Outcome was assessed by a different pharmacist who was blinded to the randomised allocation. The control group underwent usual care without a pre-consultation medication reconciliation.

Official Title
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Effectiveness of Pre-Consultation Medication Reconciliation Service in Reducing Unintentional Medication Discrepancies During Transition of Care From Hospital Discharge to Primary Care Setting- A Randomised Controlled Trial

Conditions
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Medication Administered in Error, Medication Adherence

Intervention / Treatment
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* Other: Pre-Consultation Medication Reconciliation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 21 years and older Patient or primary caregiver was able to provide informed consent Patient or primary caregiver was English, Mandarin or Malay speaking Patient was able to self-administer medications, or accompanied by a caregiver who assisted in administering medications Patient was prescribed 5 or more chronic medications The day of the study visit was the first follow-up visit in National Healthcare Group Polyclinics for chronic disease management after recent discharge from a local public hospital Exclusion Criteria: Residents of nursing home The day of the study visit was for acute illness consult Unwilling to consent to a 30-day follow-up phone call.

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pre-Consultation Medication Reconciliation<br>Participants underwent medication reconciliation service before their consultation with the attending doctor. A best possible medication history (BPMH) was created and saved as an electronic draft in the electronic medical record system. | Other: Pre-Consultation Medication Reconciliation<br>* Medication reconciliation service to be done for participants randomised to the intervention group<br>|
| No Intervention: Control<br>Participants in the control group proceeded with usual care, where the doctor reviewed the patient's condition and ordered an electronic prescription | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Unintentional medication discrepancies | Any unintentional medication discrepancies after doctor's consultation | 1 day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Types of medication discrepancies | Type of medication discrepancies, by a validated instrument by Claeys et al, (Claeys C, Neve J, Tulkens PM, Spinewine A. Content Validity and Inter-Rater Reliability of an Instrument to Characterize Unintentional Medication Discrepancies.Drugs & Aging. 2012 July; 29(7): 577-91.) | 1 day | 
| Causes of medication discrepancies | Causes of medication discrepancies, by a validated instrument by Claeys et al, (Claeys C, Neve J, Tulkens PM, Spinewine A. Content Validity and Inter-Rater Reliability of an Instrument to Characterize Unintentional Medication Discrepancies.Drugs & Aging. 2012 July; 29(7): 577-91.) | 1 day | 
| Medication adherence | Medication adherence by The 8-item Morisky Medication Adherence Scale | 30 days | 
| 30-day re-hospitalisation | rate of re-hospitalisation 30 days after the study visit | 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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medication discrepancy, primary care, transition of care