A prospective observational pilot study on medication reconciliation in a tertiary care hospital in West Bengal

Abstract

Background: Challenges faced in today´s health care system around the medication of a patient, is the lack of accurate and complete information about his pharmacotherapy; this makes the patient vulnerable in a situation of risk of medication errors which can be resulted in an ineffective therapy, or adverse effects and avoidable hospital admissions. Medication reconciliation is an unmet need to avoid medication error and patient safety. However, it can be difficult to see the true value of medication reconciliation and to commit to it professionally in an already busy and challenging work environment. Clinical Pharmacologists can help in health care by bridging this gap. The need of a Therapeutics Clinic becomes more valuable especially in a Government setup of developing country like India in the face of growing patient load where the doctor- patient ratio is heavily at odds and doctor patient interaction is also limited. Methodology: Collection of relevant data was done at the out-patients department of Therapeutics clinic or Clinical pharmacology in R. G. Kar Medical College and Hospital, Kolkata from 05.10. 2020 to 01.02.21.In the Therapeutics clinic or Clinical pharmacology out-patient department (OPD), only referred patients for medication related issues from different clinical department from this institute will be treated initially. We had given an accurate list of all medications that a patient was given from different clinical departments, even mentioned over the counter medicine and other kind of medicines in that medicine list. We had checked the medicines through drug-drug interaction checker. We had reconciled the medicine in polypharmacy and reduce unnecessary medications. Adverse drug reactions were also reported. Results: A total of 40 patients were referred to Therapeutics Clinic for medication reconciliation from 5.10. 2020 to 01.02.21.There were 80% referral from medicine department, 15% from psychiatry and 5% from other clinical (pediatrics, physical medicine and rehabilitation, orthopedics) departments. Approximately 50% referral was due to poly-pharmacy and 40% because of drug-drug interaction checking. Modifications were required for 78% patient and outcome in term of recovery was 76% and patient came back for follow up visit was 87%. Conclusion: Maximal referral is due to drug-drug interaction checking & poly-pharmacy. Outcome for this new venture in term of recovery and patient came back for next follow up visit was good. An adequately trained and informed pharmacologist, with his/her professional wisdom can add enormous value as a member in health care provider team and contribute in fulfilling the benefits of medication reconciliation. It is high time we health professionals of all categories along with clinical pharmacologist should join hands to help our patients. They may also contribute in ensuring patient compliance by reducing unnecessary pill burden and certainly provide an opportunity to educate patient about the disease and drug.