title: To what extent is clinical and laboratory information used to perform medication reviews in the nursing home setting? the CLEAR study.
abstract: BACKGROUND
  The aim of this study was to evaluate to what extent laboratory data, actual medication, medical history, and/or drug indication influence the quality of medication reviews for nursing home patients.
  
  
  METHODS
  Forty-six health care professionals from different fields were requested to perform medication reviews for three different cases. Per case, the amount of information provided varied in three subsequent stages: stage 1, medication list only; stage 2, adding laboratory data and reason for hospital admission; and stage 3, adding medical history/drug indication. Following a slightly modified Delphi method, a multidisciplinary team performed the medication review for each case and stage. The results of these medication reviews were used as reference reviews (gold standard). The remarks from the participants were scored, according to their potential clinical impact, from relevant to harmful on a scale of 3 to -1. A total score per case and stage was calculated and expressed as a percentage of the total score from the expert panel for the same case and stage.
  
  
  RESULTS
  The overall mean percentage over all cases, stages, and groups was 37.0% when compared with the reference reviews. For one of the cases, the average score decreased significantly from 40.0% in stage 1, to 30.9% in stage 2, and 27.9% in stage 3; no significant differences between stages was found for the other cases.
  
  
  CONCLUSIONS
  The low performance, against the gold standard, of medication reviews found in the present study highlights that information is incorrectly used or wrongly interpreted, irrespective of the available information. Performing medication reviews without using the available information in an optimal way can have potential implications for patient safety.
authors.affiliation: Department of Clinical Pharmacology and Toxicology, Orbis Medical Centre, Sittard, the Netherlands.
authors.forename: Carlota
authors.initials: C
authors.lastname: Mestres Gonzalvo
authors.affiliation: Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Kim Pgm
authors.initials: KP
authors.lastname: Hurkens
authors.affiliation: Department of Clinical Pharmacy and Toxicology, Atrium Medical Centre, Heerlen, the Netherlands.
authors.forename: Hugo Ajm
authors.initials: HA
authors.lastname: de Wit
authors.affiliation: Department of Clinical Pharmacology and Toxicology, Orbis Medical Centre, Sittard, the Netherlands.
authors.forename: Brigit Pc
authors.initials: BP
authors.lastname: van Oijen
authors.affiliation: Department of Clinical Pharmacology and Toxicology, Orbis Medical Centre, Sittard, the Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Janknegt
authors.affiliation: Department of Family Medicine and Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors.forename: Jos Mga
authors.initials: JM
authors.lastname: Schols
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Wubbo J
authors.initials: WJ
authors.lastname: Mulder
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg/School for Mental Health and Neurosciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Frans R
authors.initials: FR
authors.lastname: Verhey
authors.affiliation: Department of Methodology and Statistics, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.affiliation: Department of Clinical Pharmacology and Toxicology, Orbis Medical Centre, Sittard, the Netherlands.
authors.forename: Paul-Hugo M
authors.initials: PH
authors.lastname: van der Kuy
keywords: aged; decision support systems management; medication review; medication therapy management; polypharmacy