title: Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits.
abstract: OBJECTIVE
  To examine the impact of systematic medication reconciliations upon hospital admission and of a medication review while in hospital on the number of inappropriate medications and unscheduled drug-related hospital revisits in elderly patients.
  
  
  METHODS
  This was a prospective, controlled study in 210 patients, aged 65 years or older, who were admitted to one of three internal medicine wards at a University Hospital in Sweden. Intervention patients received the complete Lund Integrated Medicines Management model (medication reconciliation upon admission and discharge, and medication review and monitoring) provided by a multi-professional team, including a clinical pharmacist. Control patients received standard care and medication reconciliation upon discharge. Blinded reviewers evaluated the appropriateness of the prescribing (using the Medication Appropriateness Index) on admission and discharge, and assessed the probability that a drug-related problem was the reason for any patient readmitted to hospital or visiting the emergency department within 3 months of discharge (using World Health Organisation causality criteria).
  
  
  RESULTS
  There was a greater decrease in the number of inappropriate drugs in the intervention group than in the control group for both the intention-to-treat population {51% [95% confidence interval (CI) 43-58%] vs. 39% (95% CI 30-48%); p = 0.0446} and the per-protocol population [60% (95% CI 51-67%) vs. 44% (95% CI 34-52%); p = 0.0106)]. There were six revisits to hospital in the intervention group which were judged as 'possibly, probably or certainly drug-related', compared with 12 in the control group (p = 0.0469).
  
  
  CONCLUSIONS
  In this study, medication reconciliation and review provided by a clinical pharmacist in a multi-professional team significantly reduced the number of inappropriate drugs and unscheduled drug-related hospital revisits among elderly patients.
authors.affiliation: eHealth Institute and School of Natural Sciences, Linnaeus University, 391 82, Kalmar, Sweden. lina.hellstrom@lnu.se
authors.forename: Lina M
authors.initials: LM
authors.lastname: Hellström
authors.forename: Asa
authors.initials: A
authors.lastname: Bondesson
authors.forename: Peter
authors.initials: P
authors.lastname: Höglund
authors.forename: Patrik
authors.initials: P
authors.lastname: Midlöv
authors.forename: Lydia
authors.initials: L
authors.lastname: Holmdahl
authors.forename: Eva
authors.initials: E
authors.lastname: Rickhag
authors.forename: Tommy
authors.initials: T
authors.lastname: Eriksson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016022:Case-Control Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D059065:Medication Reconciliation / Q000706:statistics & numerical data*; D054539:Medication Therapy Management / Q000592:standards*; D010343:Patient Admission; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D016012:Poisson Distribution; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D013548:Sweden
chemical_list: D004364:Pharmaceutical Preparations