title: Drug-therapy problems, inconsistencies and omissions identified during a medication reconciliation and seamless care service.
abstract: Seamless care is the desirable continuity of care delivered to a patient in the healthcare system across the spectrum of caregivers and their environments. Medication Reconciliation is one component of seamless pharmaceutical care. A randomized controlled trial, carried out over nine months with a six-month follow-up period, investigated the impact of a pharmacist-directed seamless care service. Intervention patients admitted to one of two general medicine units were subjected to a comprehensive seamless care discharge process as they were discharged from a regional, academically affiliated hospital in Moncton, NB. The number, type and potential clinical impact of drug-therapy problems for seamless monitoring (DTPsm) and drug-therapy inconsistencies and omissions (DTIOs) in hospital discharge medications were measured. A total of 253 patients, with 134 patients in the intervention group and 119 in the control group, completed the study. An average of 3.59 DTPsm per intervention patient, with 72.1% of these being scored as having a significant or very significant clinical impact level, were communicated to community pharmacists. Ninety-nine DTIOs were identified and resolved in intervention patients before discharge. A retrospective medical chart review demonstrated that the intervention resolved almost all DTIOs. In conclusion, a pharmacist-directed seamless care service had a significant impact on drug-related clinical outcomes and processes of care.
authors.affiliation: South-East Regional Health Authority, Moncton, NB.
authors.forename: Ann
authors.initials: A
authors.lastname: Nickerson
authors.forename: Neil J
authors.initials: NJ
authors.lastname: MacKinnon
authors.forename: Nancy
authors.initials: N
authors.lastname: Roberts
authors.forename: Lauza
authors.initials: L
authors.lastname: Saulnier
mesh_terms: D000368:Aged; D002170:Canada; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D008509:Medication Systems / Q000458:organization & administration*; D008875:Middle Aged; D009313:National Health Programs; D009509:New Brunswick