Impact of an integrated medication reconciliation model led by a hospital clinical pharmacist on the reduction of post-discharge unintentional discrepancies.

WHAT IS KNOWN AND OBJECTIVE: There is no optimal standardized model in the transfer of care between hospitals and primary healthcare facilities. Transfer of care is a critical point during which unintentional discrepancies, that can jeopardize pharmacotherapy outcomes, can occur. The objective was to determine the effect that an integrated medication reconciliation model has on the reduction of the number of post-discharge unintentional discrepancies. METHODS: A randomized controlled study was conducted on an elderly patient population. The intervention group of patients received a medication reconciliation model, led entirely by a hospital clinical pharmacist (medication reconciliation at admission, review and optimization of pharmacotherapy during hospitalization, patient education and counselling, medication reconciliation at discharge, medication reconciliation as part of primary health care in collaboration with a primary care physician and a community pharmacist). Unintentional discrepancies were identified by comparing the medications listed on the discharge summary with the first list of medications prescribed and issued at primary care level, immediately after discharge. The main outcome measures were incidence, type and potential severity of post-discharge unintentional discrepancies. RESULTS AND DISCUSSION: A total of 353 patients were analysed (182 in the intervention and 171 in the control group). The medication reconciliation model, led by a hospital clinical pharmacist, significantly reduced the number of patients with unintentional discrepancies by 57.1% (p < 0.001). The intervention reduced the number of patients with unintentional discrepancies associated with a potential moderate harm by 58.6% (p < 0.001) and those associated with a potential severe harm by 68.6% (p = 0.039). The most common discrepancies were incorrect dosage, drug omission and drug commission. Cardiovascular medications were most commonly involved in unintentional discrepancies. WHAT IS NEW AND CONCLUSION: The integrated medication reconciliation model, led by a hospital clinical pharmacist in collaboration with all health professionals involved in the patient's pharmacotherapy and treatment, significantly reduced unintentional discrepancies in the transfer of care.

Prevalence and impact of pre-pregnancy body mass index on pregnancy outcome: a cross-sectional study in Croatia.

The aim of this study was to determine the association of maternal pre-pregnancy body mass index (BMI) and pregnancy outcome among pregnant women in Croatia. Women who gave birth in Croatia in 2017 were categorised into four groups according to pre-pregnancy BMI and analysed regarding maternal characteristics and perinatal outcomes. Among 32,051 pregnant women, 5.3% were underweight, 65.5% had normal BMI, 20.4% were overweight and 8.8% were obese. Overweight and obese women had a higher prevalence of induction of labour and delivery by caesarean section compared to normal-BMI women (p < .001), while underweight and obese women had a higher prevalence of preterm birth (p < .001). Gestational diabetes (GD), gestational hypertension and preeclampsia were higher in overweight and obese group. Multivariate logistic regression model showed that older maternal age, higher BMI, GD, gestational hypertension and preeclampsia were significant predictors of having non-spontaneous onset of labour and of not delivering vaginally.Impact statementWhat is already known on this subject? Women with abnormal body mass index (BMI) compared to women with normal BMI have an increased risk of various complications during pregnancy and labour such as preterm birth and low birth weight for underweight women, and foetal macrosomia, labour induction and delivery by caesarean section for obese women.What do the results of this study add? This study was performed on a large national cohort of pregnant women and its results show that the majority of adverse perinatal outcomes present in obese women are also present among overweight women. Additional attention should be paid to women with a modest increase in BMI who present the majority of women with abnormal BMI.What are the implications of these findings for clinical practice and/or further research? Risks identified in this study must be acknowledged and taken into account when counselling and managing women before and during pregnancy and labour. Women must be encouraged throughout pregnancy to either gain weight or limit weight gain if they are in adverse BMI group.

Prevalence of diabetes five years after having gestational diabetes during pregnancy - Croatian national study.

AIMS: The aim of this study was to determine the prevalence of diabetes among women 5 years after having gestational diabetes during pregnancy. Also, we sought to determine whether women who develop diabetes after GD during pregnancy differ from women who do not develop diabetes after GD during pregnancy. METHODS: This longitudinal study was performed using data from medical birth certificates and CroDiab diabetes registry. Women burdened with gestational diabetes in Croatia in 2011 were followed up until year 2016. Those registered in CroDiab registry were recognised as new patients with diabetes. RESULTS: Among 40,641 deliveries in 2011, gestational diabetes was reported in 1181 (2.9%) women. Among them 853 (72.23%) were followed up in CroDiab diabetes registry and 32 (3.75%) were identified as new patients with diabetes. Median time from childbirth to onset of diabetes was 29.12 months. The diabetes group did not significantly differ to the group without diabetes according to age (p=0.587), level of education (p=0.549) or marital status (p=0.849) except that the diabetes group was significantly more obese than the group without diabetes (p=0.002). CONCLUSIONS: Based on CroDiab diabetes registry data prevalence of diabetes 5 years after pregnancy complicated with gestational diabetes is 3.75% in Croatia. Women with gestational diabetes during pregnancy, and especially those with higher BMIs, are an important risk group for developing diabetes later in life so screening and preventive measures should be oriented toward them in primary care settings.