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4CPS-035 Pharmacist-led medication reconciliation at discharge shall not be sufficient to reduce unplanned healthcare utilisation: hear the patient experience!
  1. F Laval1,
  2. R Lhermitte2,
  3. L Alix3,
  4. D Somme4,
  5. B Marie-Dit-Dinard2,
  6. V Gicquel1,
  7. A Bacle1,
  8. B Hue1,
  9. E Bajeux5
  1. 1CHU Rennes – Hôpital de Ponchaillou, Service de Pharmacie, Rennes, France
  2. 2CH de Fougeres, Service de Pharmacie, Rennes, France
  3. 3CHU Rennes – Hôpital de Ponchaillou, Service de Médecine Interne, Rennes, France
  4. 4CHU Rennes – Hôpital de Ponchaillou, Service de Gériatrie Aiguë, Rennes, France
  5. 5CHU Rennes – Hôpital de Ponchaillou, Service d’Épidémiologie et de Santé Publique, Rennes, France


Background and importance Older patients often experience adverse drug events (ADEs) after discharge that may lead to unplanned readmission. Pharmacist-led medication reconciliation at discharge (MRD) is known to reduce medication errors that lead to ADE but results on healthcare utilisation are controversial.

Aim and objectives The main aim of this study was to evaluate the MRD’s effect provided to patients aged over 65 years on their unplanned rehospitalisation for ADE within 30 days. A secondary objective was to assess the impact of the pharmacist’s presence on patient experience and knowledge about their treatment.

Material and methods An observational, multicentre prospective study, in medical and rehabilitation wards in 5 hospitals in Brittany, France. Included patients were aged 65 years and over who received MR at admission (MRA). A pharmacist-led MRD was the intervention. The primary endpoint was the proportion of patients experiencing death, unplanned rehospitalisation and/or visit to an emergency department within 30 days after discharge. Secondary endpoints encompassed the patient’s experience of discharge and knowledge about their medication changes.

Results Patients who received MRA and MRD did not have significantly fewer deaths, unplanned rehospitalisations and/or emergency visits related to ADE or other (p=0.960) 30 days after discharge than patients receiving MRA alone.

The discharge from hospital seemed well organised for these patients (p=0.003) and they reported more frequently that their community pharmacist and general practitioner received information about their hospital stay (p=0.036).

In the intervention group (n=221), 74.9% of patients had an interview with a pharmacist but only 47.8% reported any conversation with a healthcare professional about their medication.

41% of patients who received MRA did not have MRD (n=153), mainly because the pharmacist was not notified of the patient’s discharge or because of a lack of time.

Conclusion and relevance This study found no effect on MRD on healthcare utilisation 30 days after discharge on patients aged over 65 years. MRD significantly improved the patient’s experience of seamless care after discharge. Patients’ knowledge about their medications still offers scope for improvement. A better integration of pharmacists in care services seems necessary to improve the process, and the best time for the patient’s interview remains under discussion.

References and/or acknowledgements The authors acknowledge the French Ministry of Health for financial support.

Conflict of interest No conflict of interest

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