title: [Medication reconciliation in primary care after hospital discharge].
abstract: OBJECTIVE
  The primary objective of this study was to determine if changes prescribed in the usual treatment of patients at discharge from the hospital were updated in their active treatment sheet when they came to the Primary Care clinic. The secondary objectives included, determining whether the drug average varies between the admission and discharge, as well as, identifying other factors related to the modification of treatment during hospital admission including, among others, patient age or the number of drugs previously indicated. Finally, the relationship between the Primary Care Unit to which the patient belonged and the probability that the medication was reconciled was also examined.
  
  
  METHODS
  This is an observational cross-sectional study conducted in the Bidasoa Integrated Healthcare Organization. The study included every patient over 65 years old with multiple medication (taking 5 or more drugs) belonging to this organization, and discharged from Bidasoa Hospital between 15th October and 11th November 2012. The information on hospital discharges during this period was sent from the hospital to those responsible for patient safety in the Primary Health Care Centers. Each patient clinical history was reviewed in order to confirm if a visit (at least once in the first two weeks after discharge) had been made to their Primary Care Unit, and whether there had been a change in their active treatment sheet.
  
  
  RESULTS
  Two hundred sixty-one patients (n=261) were discharged from Bidasoa Hospital in the study period, and 80 met the inclusion criteria. The discharge report proposed a change in the active treatment in 39 of them (49%). Of these, 35 (90%) attended a Primary Care clinic, and the changes were included in their active treatment sheet in 24 patients, representing 68% of those who contacted Primary Care, and 61% of those who would have required changes.
  
  
  CONCLUSIONS
  The results demonstrate the need to establish a reconciliation medication program for patients on multiple medications after hospital discharge. Moreover, further studies are needed to investigate what may be the reasons why the changes to active treatment sheets are not taking place for some patients, despite these having visited Primary Care after having been discharged from hospital.
authors.affiliation: Servicio de Farmacia, OSI Bidasoa, Hospital Bidasoa, Hondarribi, Guipúzcoa, España. Electronic address: elena.valverdebilbao@osakidetza.net.
authors.forename: E
authors.initials: E
authors.lastname: Valverde-Bilbao
authors.affiliation: Servicio de Farmacia, OSI Bidasoa, Hospital Bidasoa, Hondarribi, Guipúzcoa, España.
authors.forename: A
authors.initials: A
authors.lastname: Mendizabal-Olaizola
authors.affiliation: C.S. Dunboa, OSI Bidasoa, Irún, Guipúzcoa, España.
authors.forename: I
authors.initials: I
authors.lastname: Idoiaga-Hoyos
authors.affiliation: C.S. Irún-centro, OSI Bidasoa, Irún, Guipúzcoa, España.
authors.forename: L
authors.initials: L
authors.lastname: Arriaga-Goirizelai
authors.affiliation: C.S. Hondarribi, OSI Bidasoa, Hondarribi, Guipúzcoa, España.
authors.forename: J D
authors.initials: JD
authors.lastname: Carracedo-Arrastio
authors.affiliation: Unidad de Continuidad Asistencial, OSI Bidasoa, Hospital Bidasoa, Hondarribi, Guipúzcoa, España.
authors.forename: C
authors.initials: C
authors.lastname: Arranz-Lázaro
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D006801:Humans; D059065:Medication Reconciliation; D010351:Patient Discharge; D011320:Primary Health Care
keywords: Alta hospitalaria; Atención primaria; Conciliación de la medicación; Hospital discharge; Medication reconciliation; Patient safety; Primary care; Seguridad del paciente