Conciliación de la medicación en atención primaria tras el alta hospitalaria / Medication reconciliation in primary care after hospital discharge

Objetivos: El objetivo primario de este estudio es comprobar si la información de los cambios propuestos en el tratamiento habitual de los pacientes al alta hospitalaria se traslada a su hoja de tratamiento activo cuando acuden a atención primaria. Se plantean objetivos secundarios como analizar la media de medicamentos por paciente al ingreso y al alta; identificar otros factores que pudieran influir en la modificación del tratamiento durante el ingreso (edad del paciente o número de fármacos previamente indicados, entre otros). También se analiza la relación entre el centro de salud al que pertenece el paciente y la probabilidad de que se concilie su medicación cuando acude a atención primaria. Material y métodos: Se trata de un estudio transversal observacional, desarrollado en la Organización Sanitaria Integrada Bidasoa. Se incluyó a todos los pacientes mayores de 65 años polimedicados (que tomaban 5 o más fármacos) de la organización, dados de alta en el Hospital Bidasoa entre el 15 de octubre y el 11 de noviembre de 2012. Las altas producidas en este periodo se enviaron desde el hospital a cada responsable de seguridad del paciente de los centros de atención primaria, y a través de la revisión de la historia clínica de cada paciente se obtuvo información relativa a si habían acudido a su centro en los 15 días posteriores al alta, así como de si se efectuó alguna modificación en la hoja de tratamiento activo. Resultados: Doscientos sesenta y un pacientes (n = 261) fueron dados de alta en el periodo de estudio, de los cuales 80 cumplían los criterios de inclusión. El informe de alta de 39 de ellos (49%) proponía algún cambio en su hoja de tratamiento activo. De ellos, 35 (90%) se pusieron en contacto con atención primaria, y en 24 pacientes los cambios fueron incluidos en su hoja de tratamiento activo, lo que supone el 68% de los que contactaron con atención primaria y el 61% de los que hubieran requerido cambios. Conclusiones: Los resultados observados en este estudio nos llevan a pensar en la necesidad de establecer un programa de conciliación de la medicación para los pacientes polimedicados al alta hospitalaria. Además, consideramos interesante ahondar en los motivos por los cuales los pacientes que a pesar de haber acudido a atención primaria tras el alta hospitalaria, no vieron trasladados los cambios de la medicación a su hoja de tratamiento activo (AU)

Objectives: The primary objective of this study was to determine if changes prescribed in the usual treatment of patients at discharge from the hospital were updated in their active treatment sheet when they came to the Primary Care clinic. The secondary objectives included, determining whether the drug average varies between the admission and discharge, as well as, identifying other factors related to the modification of treatment during hospital admission including, among others, patient age or the number of drugs previously indicated. Finally, the relationship between the Primary Care Unit to which the patient belonged and the probability that the medication was reconciled was also examined. Material and methods: This is an observational cross-sectional study conducted in the Bidasoa Integrated Healthcare Organization. The study included every patient over 65 years old with multiple medication (taking 5 or more drugs) belonging to this organization, and discharged from Bidasoa Hospital between 15th October and 11th November 2012. The information on hospital discharges during this period was sent from the hospital to those responsible for patient safety in the Primary Health Care Centers. Each patient clinical history was reviewed in order to confirm if a visit (at least once in the first two weeks after discharge) had been made to their Primary Care Unit, and whether there had been a change in their active treatment sheet. Results: Two hundred sixty-one patients (n = 261) were discharged from Bidasoa Hospital in the study period, and 80 met the inclusion criteria. The discharge report proposed a change in the active treatment in 39 of them (49%). Of these, 35 (90%) attended a Primary Care clinic, and the changes were included in their active treatment sheet in 24 patients, representing 68% of those who contacted Primary Care, and 61% of those who would have required changes. Conclusions: The results demonstrate the need to establish a reconciliation medication program for patients on multiple medications after hospital discharge. Moreover, further studies are needed to investigate what may be the reasons why the changes to active treatment sheets are not taking place for some patients, despite these having visited Primary Care after having been discharged from hospital

[Medication reconciliation in primary care after hospital discharge]. / Conciliación de la medicación en atención primaria tras el alta hospitalaria.

OBJECTIVES: The primary objective of this study was to determine if changes prescribed in the usual treatment of patients at discharge from the hospital were updated in their active treatment sheet when they came to the Primary Care clinic. The secondary objectives included, determining whether the drug average varies between the admission and discharge, as well as, identifying other factors related to the modification of treatment during hospital admission including, among others, patient age or the number of drugs previously indicated. Finally, the relationship between the Primary Care Unit to which the patient belonged and the probability that the medication was reconciled was also examined. MATERIAL AND METHODS: This is an observational cross-sectional study conducted in the Bidasoa Integrated Healthcare Organization. The study included every patient over 65 years old with multiple medication (taking 5 or more drugs) belonging to this organization, and discharged from Bidasoa Hospital between 15th October and 11th November 2012. The information on hospital discharges during this period was sent from the hospital to those responsible for patient safety in the Primary Health Care Centers. Each patient clinical history was reviewed in order to confirm if a visit (at least once in the first two weeks after discharge) had been made to their Primary Care Unit, and whether there had been a change in their active treatment sheet. RESULTS: Two hundred sixty-one patients (n=261) were discharged from Bidasoa Hospital in the study period, and 80 met the inclusion criteria. The discharge report proposed a change in the active treatment in 39 of them (49%). Of these, 35 (90%) attended a Primary Care clinic, and the changes were included in their active treatment sheet in 24 patients, representing 68% of those who contacted Primary Care, and 61% of those who would have required changes. CONCLUSIONS: The results demonstrate the need to establish a reconciliation medication program for patients on multiple medications after hospital discharge. Moreover, further studies are needed to investigate what may be the reasons why the changes to active treatment sheets are not taking place for some patients, despite these having visited Primary Care after having been discharged from hospital.