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Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety

Discrepancies between the medicines consumed by patients and those documented in the medical record can affect medication safety. We aimed to characterize medication discrepancies and medication regimen complexity over time in a cohort of outpatients with decompensated cirrhosis, and evaluate the im...

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Autores principales: Hayward, Kelly L., Valery, Patricia C., Patel, Preya J., Li, Catherine, Horsfall, Leigh U., Wright, Penny L., Tallis, Caroline J., Stuart, Katherine A., David, Michael, Irvine, Katharine M., Cottrell, Neil, Martin, Jennifer H., Powell, Elizabeth E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8703811/
https://www.ncbi.nlm.nih.gov/pubmed/34959611
http://dx.doi.org/10.3390/ph14121207
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author Hayward, Kelly L.
Valery, Patricia C.
Patel, Preya J.
Li, Catherine
Horsfall, Leigh U.
Wright, Penny L.
Tallis, Caroline J.
Stuart, Katherine A.
David, Michael
Irvine, Katharine M.
Cottrell, Neil
Martin, Jennifer H.
Powell, Elizabeth E.
author_facet Hayward, Kelly L.
Valery, Patricia C.
Patel, Preya J.
Li, Catherine
Horsfall, Leigh U.
Wright, Penny L.
Tallis, Caroline J.
Stuart, Katherine A.
David, Michael
Irvine, Katharine M.
Cottrell, Neil
Martin, Jennifer H.
Powell, Elizabeth E.
author_sort Hayward, Kelly L.
collection PubMed
description Discrepancies between the medicines consumed by patients and those documented in the medical record can affect medication safety. We aimed to characterize medication discrepancies and medication regimen complexity over time in a cohort of outpatients with decompensated cirrhosis, and evaluate the impact of pharmacist-led intervention on discrepancies and patient outcomes. In a randomized-controlled trial (n = 57 intervention and n = 57 usual care participants), medication reconciliation and patient-oriented education delivered over a six-month period was associated with a 45% reduction in the incidence rate of ‘high’ risk discrepancies (IRR = 0.55, 95%CI = 0.31–0.96) compared to usual care. For each additional ‘high’ risk discrepancy at baseline, the odds of having ≥ 1 unplanned medication-related admission during a 12-month follow-up period increased by 25% (adj-OR = 1.25, 95%CI = 0.97–1.63) independently of the Child–Pugh score and a history of variceal bleeding. Among participants with complete follow-up, intervention patients were 3-fold less likely to have an unplanned medication-related admission (adj-OR = 0.27, 95%CI = 0.07–0.97) compared to usual care. There was no association between medication discrepancies and mortality. Medication regimen complexity, frequent changes to the regimen and hepatic encephalopathy were associated with discrepancies. Medication reconciliation may improve medication safety by facilitating communication between patients and clinicians about ‘current’ therapies and identifying potentially inappropriate medicines that may lead to harm.
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spelling pubmed-87038112021-12-25 Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety Hayward, Kelly L. Valery, Patricia C. Patel, Preya J. Li, Catherine Horsfall, Leigh U. Wright, Penny L. Tallis, Caroline J. Stuart, Katherine A. David, Michael Irvine, Katharine M. Cottrell, Neil Martin, Jennifer H. Powell, Elizabeth E. Pharmaceuticals (Basel) Article Discrepancies between the medicines consumed by patients and those documented in the medical record can affect medication safety. We aimed to characterize medication discrepancies and medication regimen complexity over time in a cohort of outpatients with decompensated cirrhosis, and evaluate the impact of pharmacist-led intervention on discrepancies and patient outcomes. In a randomized-controlled trial (n = 57 intervention and n = 57 usual care participants), medication reconciliation and patient-oriented education delivered over a six-month period was associated with a 45% reduction in the incidence rate of ‘high’ risk discrepancies (IRR = 0.55, 95%CI = 0.31–0.96) compared to usual care. For each additional ‘high’ risk discrepancy at baseline, the odds of having ≥ 1 unplanned medication-related admission during a 12-month follow-up period increased by 25% (adj-OR = 1.25, 95%CI = 0.97–1.63) independently of the Child–Pugh score and a history of variceal bleeding. Among participants with complete follow-up, intervention patients were 3-fold less likely to have an unplanned medication-related admission (adj-OR = 0.27, 95%CI = 0.07–0.97) compared to usual care. There was no association between medication discrepancies and mortality. Medication regimen complexity, frequent changes to the regimen and hepatic encephalopathy were associated with discrepancies. Medication reconciliation may improve medication safety by facilitating communication between patients and clinicians about ‘current’ therapies and identifying potentially inappropriate medicines that may lead to harm. MDPI 2021-11-23 /pmc/articles/PMC8703811/ /pubmed/34959611 http://dx.doi.org/10.3390/ph14121207 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hayward, Kelly L.
Valery, Patricia C.
Patel, Preya J.
Li, Catherine
Horsfall, Leigh U.
Wright, Penny L.
Tallis, Caroline J.
Stuart, Katherine A.
David, Michael
Irvine, Katharine M.
Cottrell, Neil
Martin, Jennifer H.
Powell, Elizabeth E.
Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety
title Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety
title_full Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety
title_fullStr Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety
title_full_unstemmed Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety
title_short Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety
title_sort medication discrepancies and regimen complexity in decompensated cirrhosis: implications for medication safety
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8703811/
https://www.ncbi.nlm.nih.gov/pubmed/34959611
http://dx.doi.org/10.3390/ph14121207
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