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Determinants for medication reconciliation interventions on hospital admission and discharge: An observational multi-centre study

  • C.C.M. Stuijt
    Correspondence
    Corresponding author at: Michelangelostraat 62-2, 1077CG Amsterdam, The Netherlands.
    Affiliations
    ApoMed, Amsterdam, The Netherlands

    University Medical Center Groningen, Department of Neurology, University of Groningen, Groningen, The Netherlands
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  • B. vd Bemt
    Affiliations
    Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands

    Pharmacy University Medical Centre, Radboud University Medical Centre, Nijmegen, The Netherlands
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  • V.E. Boerlage
    Affiliations
    Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands

    Vlaslant Pharmacy, Valkenswaard, The Netherlands
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  • K. Taxis
    Affiliations
    Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
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  • F. Karapinar
    Affiliations
    Department of Hospital Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
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Published:September 13, 2017DOI:https://doi.org/10.1016/j.ejim.2017.09.001
      MR is the process of creating and maintaining an, as accurate as possible, overview of patient's actual medication use, in order to prescribe and provide correct medication to the patient at all transition points and avoid unintended medication discrepancies [
      • Institute For Healthcare Improvement
      Reconcile medications at all transition points.
      ]. However, MR services are time consuming and only a relatively small proportion of patients are affected by clinically significant unintended discrepancies [
      • Boockvar K.
      • Liu S.
      • Goldstein N.
      • Nebeker J.
      • Siu A.
      • Fried T.
      Prescribing discrepancies likely to cause adverse drug events after patient transfer.
      ,
      • Schnipper J.L.
      • Kirwin J.L.
      • Cotugno M.C.
      • Wahlstrom S a, Brown B a, Tarvin E, et al
      Role of pharmacist counseling in preventing adverse drug events after hospitalization.
      ]. This makes a MR service difficult to implement. Targeting high risk patients might increase the efficiency of MR services facilitating implementation. Determinants for high risk patients are however sparsely available. Therefore, we executed a large, multi-centre, retrospective cohort study to assess determinants for MR interventions both on admission and discharge. Secondly, the type and frequency of MR interventions was determined.
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