Aguilar Santamaria J1., Amaro Cendón L1., López Torres Mª Rosa1., Recio Jaraba C1., Valles Martin E2., Calvo Boyero F2., Garcia López L2., Martin Suarez A2., Varas Doval R1., Vargas Cosin B1.1- General Pharmaceutical Council of Spain (CGCOF). 2- University of Salamanca.

Concilia Medicamentos Programme:Reconciliation of medication at hospital discharge in community pharmacy.

Pharmaceutical Sciences Pharmacy Practice Research.

Subject area

The General Pharmaceutical Council of Spain, the Pharmaceutical Care Forum in Community Pharmacy, the Spanish Society for Hospital Pharmacists, the University of Salamanca and the Provincial Pharmacy Chambers have worked on a methodology and terminology for a Reconciliation Service in Community Pharmacy to ensure continuity between care transitions. The project has supported by Cinfa.

Background

A prospective, without control group, non-randomised, multicentre observational study in patients presenting a hospital discharge report (last 72 hours) and taking medication on a regular basis. A computer application was created for the registration of data and communication between the different levels of care.

Methods

In only 15 patients, no discrepancy was detected, which shows the high incidence of the problem and the need to implement this service. Furthermore, it was observed that community pharmacists detect a greater number of discrepancies by omission of medicines, as they also assess treatments without prescription.

Conclusions

263

30 community pharmacists, 17 hospital pharma-cist and 3 from primary care participated.

120 patients reconciled: 86 by hospital pharma-cists and 34 by community pharmacists.

67% were older (70.69 ± 12.55 years) polymedi-cated (10.65 ± 2.59 mean medication / patient)

87.5% presented some discrepancy at discharge (3.49 mean number of discrepancies / patient)

336 discrepancies (237 por HP y 99 por CP);l 76% justified and 24% requiring clarification by the prescribing physician

After clarification, 6.5% were not justified, having been considered medication errors.

The communication and registration system worked properly.

Results

Patients(%) N=120

Discrepancies(%) N=336 (3.49/patient)

Without discrepancies 12%

Justified discrepancies and requiring clarification discrepancies 76%

Conciliation errors 12%

Justified by the pharmacist 76%

Justified by the prescribing physician 15%

Pending resolution 9%

To design the necessary protocols and tools for the reconciliation service, evaluating them and analysing discrepancies and errors during the process.

Objectives

Were you just h�pital�ed and you have some changes

in your medication?

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