In-hospital medication reviews reduce unidentified drug-related problems

Eur J Clin Pharmacol. 2013 Mar;69(3):647-55. doi: 10.1007/s00228-012-1368-5. Epub 2012 Sep 7.


Purpose: To examine the impact of a new model of care, in which a clinical pharmacist conducts structured medication reviews and a multi-professional team collates systematic medication care plans, on the number of unidentified DRPs in a hospital setting.

Methods: In a prospective two-period study, patients admitted to an internal medicine ward at the University Hospital of Lund, Sweden, were included if they were ≥ 65 years old, used ≥ 3 medications on a regular basis and had stayed on the ward for ≥ 5 weekdays. Intervention patients were given the new model of care and control patients received conventional care. DRPs were then retrospectively identified after study completion from blinded patient records for both intervention and control patients. Two pairs of evaluators independently evaluated and classified these DRPs as having been identified/unidentified during the hospital stay and according to type and clinical significance. The primary endpoint was the number of unidentified DRPs, and the secondary endpoints were the numbers of unidentified DRPs within each type and clinical significance category.

Results: The study included a total of 141 (70 intervention and 71 control) patients. The intervention group benefited from a reduction in the total number of unidentified DRPs per patient during the hospital stay: intervention group median 1 (1st-3rd quartile 0-2), control group 9 (6-13.5) (p < 0.001), and also in the number of medications associated with unidentified DRPs per patient: intervention group 1 (0-2), control group 8 (5-10) (p < 0.001). All sub-categories of DRPs that were frequent in the control group were significantly reduced in the intervention group. Similarly, the DRPs were less clinically significant in the intervention group.

Conclusions: A multi-professional team, including a clinical pharmacist, conducting structured medication reviews and collating systematic medication care plans proved very effective in reducing the number of unidentified DRPs for elderly in-patients.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Attitude of Health Personnel
  • Cooperative Behavior
  • Drug-Related Side Effects and Adverse Reactions
  • Female
  • Health Knowledge, Attitudes, Practice
  • Hospitals, University
  • Humans
  • Interdisciplinary Communication
  • Length of Stay
  • Male
  • Medication Adherence
  • Medication Reconciliation*
  • Patient Care Team
  • Pharmacists
  • Pharmacy Service, Hospital*
  • Polypharmacy
  • Prospective Studies
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors