Clinical trial NCT04165889: Hospital Medication Report
Official title: Evaluation of the Establishment of a Hospital Medication Report for Pharmacists and General Practitioners
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Drug Related Problem
Keywords: hospitalized in internal medicine unit
adult patient
Medication Error
Clinical Pharmacist
Lead sponsor: University Hospital, Montpellier
Sponsor class: OTHER
First posted: 2019-11-18
Enrollment: 280
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Study population was composed of patient hospitalized in Montpellier University hospital.

Brief summary: Drug Related Problem (DRP) is defined as an event that may potentially affect the health outcomes in the patients. DRPs can occur at all stages of the medication usage process starting from prescribing (included medication error and inappropriate prescription) to dispensing stage. Lack of follow-ups and reassessment of therapeutic outcomes may also contribute to DRPs. Pharmaceutical care is a co-operative activity in concert with other health care professionals and offered directly to the patient for improved quality use of medicines. Pharmaceutical care identifies and resolves actual or potential DRPs.

In our clinical practice, during the patient admission in internal medicine unit, a medication reconciliation process was conducted according to a validated protocol. The first step consists of getting the Best Possible Medication History (BPMH), defined as the most comprehensive list of all medications taken by the patient. The second step consists of comparing the BPMH with admission prescription made by the physician in charge. During pharmacist interview, pharmacist discussed about medication adherence and knowledge. The third step consists of characterizing, solving and documenting DRPs.

During the patient's hospitalization, the pharmacist participates at the medication prescription revision. At the discharge of hospitalization, a pharmaceutical standardised interview is carried out during which the pharmacist explains the modifications of treatments to the patient. During this interview, the hospital pharmacist updates the latest treatment changes. For patient with more than 65 years old and long-term affection (or patient with more than 75 years old with or without long-term affection) and 5 medications, the hospital pharmacist write a medication discharge report (MDR) to patient, community pharmacist and general practitioner.

For each medication, the investigators collected its name, dosage, dosage forms and frequency of administration. For each DRP, the investigators collected the type of DRP and the drug classes (according to anatomical therapeutic chemical classification system).

For each MDR, the investigators collected number of medication, number and type of DRP including inappropriate prescription.


Eligibility criteria: Inclusion criteria:

- Patients aged above 18 years old, admitted to the medicine unit during the study period and hospitalized for at least 24 hours

Exclusion criteria:

- NA

Primary outcomes:
measure: number of patients with MDR
timeFrame: 1 day
Secondary outcomes:
measure: number of patients with MDR and DRP
timeFrame: 1 day
Other outcomes:
Locations:
city: Montpellier
country: France
facility: Uhmontpellier
Study officials:
affiliation: University Hospital, Montpellier
name: Cyril BREUKER
role: PRINCIPAL_INVESTIGATOR
References: