RESUMEN
Objetivo: Principal: medir el impacto en la tasa de reingreso a los 30 días de un programa de conciliación terapéutica al ingreso y al alta en pacientes mayores de 65 años. Secundarios: detectar, clasificar y analizar las discrepancias, errores de conciliación (EC) y prescripción de medicamentos potencialmente inadecuados (MPI). Material y Método: Estudio observacional prospectivo, no controlado, no aleatorizado, unicéntrico, con pacientes mayores de 65 años, ingresados en Medicina Interna y Geriatría. Se realizó conciliación terapéutica al ingreso y al alta, registrando medicación habitual, discrepancias justificadas, no justificadas, EC, MPI y medicamentos de alto riesgo (MAR). Se calculó la tasa de reingreso y se comparó con la tasa del año 2013 para cada servicio médico. Resultados: 91 pacientes con una media de 86 (71-99) años, el 47% con MAR y 8,9 medicamentos crónicos por paciente. Se conciliaron 1113 medicamentos, con 836 discrepancias justificadas, 56 EC y 36 MPI. Los EC se produjeron por omisión (n=34), diferente dosis o vía (n=16), prescripción incompleta (n=1), medicamento equivocado (n=1) y comisión (n=19). Por gravedad se detectaron en las categorías B (n=16), C (n=30), D (n=9) y E (n=1). El 31,9% de los pacientes tuvo un EC. Las tasas de reingreso para Medicina Interna y Geriatría fueron respectivamente de 12,2% y 14,3% frente a las globales de 2013 de 17,9% (RR=0,652; IC95% 0,279-1,521; p=0,322) y 16,3% (RR=0,895; IC95% 0,443-1,812; p=0,758). Conclusiones: Las tasas de reingreso a los 30 días en los pacientes conciliados fueron inferiores a las globales de 2013, aunque no estadísticamente significativas
Objective: To measure the impact of a pharmacist-based medication reconciliation program on readmission rates 30 days after its implementation, at admission and discharge, in patients aged 65 years and older. Secondary objectives were to detect and classify medication discrepancies, reconciliation errors (RE) and the prescription of potentially inappropriate medications in elderly patients (PIM). Methods: Prospective observational, uncontrolled, nonrandomized, single-center study performed in patients aged 65 years and older, hospitalized in the Internal Medicine and Geriatrics units. Medication reconciliation was performed by a pharmacist at admission and discharge. The pharmacist recorded chronic medication, justified and unjustified discrepancies, RE, PIM and high-risk medications (HRM). 30-day readmission rate was calculated and then compared with the 2013 rate for each medical unit. Results: A total of 91 patients were included, with an average age of 86 (71-99) years, 47% with HRM and 8.9 chronic medications per patient. 1113 medications were reconciled, of which 836 had justified discrepancies, 56 RE and 36 PIM. The RE were caused by omission (n=34), discrepancies in via or dose (n=16), incomplete prescription (n=1), wrong drug (n=1) and commission (n=19). Regarding its seriousness, RE were classified as B (n=16), C (n=30), D (n=9) and E (n=1). 31.9% of the patients had a RE. 30-day readmission rates for Internal Medicine and Geriatrics units were respectively 12,2% and 14,3%, compared with 2013 overall rate of 17,9% (RR=0,652; IC95% 0,279-1,521; p=0,322) and 16,3% (RR=0,895; IC95% 0,443-1,812; p=0,758). Conclusions: 30-day readmission rates were lower than 2013 overall rate with the medication reconciliation program. However, this is not statistically significant