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Open Access Research article

A multicentre, double-blind, randomised, controlled, parallel-group study of the effectiveness of a pharmacist-acquired medication history in an emergency department

Jesus Becerra-Camargo1*, Fernando Martinez-Martinez2 and Emilio Garcia-Jimenez2

Author Affiliations

1 Pharmacy Department, Universidad Nacional de Colombia, Ciudad Universitaria, Edificio 450 oficina 204, Bogotá 14490, Colombia

2 Pharmacy Department, Universidad de Granada, Granada University’s pharmaceutical care research institute, Paseo Cartuja, S/N, 18071 Granada, Spain

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BMC Health Services Research 2013, 13:337  doi:10.1186/1472-6963-13-337

Published: 29 August 2013

Abstract

Background

Admission to an emergency department (ED) is a key vulnerable moment when patients are at increased risk of medication discrepancies and medication histories are an effective way of ensuring that fewer errors are made. This study measured whether a pharmacist-acquired medication history in an ED focusing on a patient’s current home medication regimen, and available to be used by a doctor when consulting in the ED, would reduce the number of patients having at least 1 medication discrepancy related to home medication.

Methods

This multicentre, double-blind, randomised, controlled parallel-group study was conducted at 3 large teaching hospitals. Two hundred and seventy participants were randomly allocated to an intervention (n = 134) or a standard care (n = 136) arm. All consecutive patients >18 years old admitted through the ED were eligible. The intervention consisted of pharmacists conducting a standardised comprehensive medication history interview focusing on a patient’s current home medication regimen, prior to being seen by a doctor. Data recorded on the admission medication order form was available to be used by a doctor during consultation in the ED. The admission medication order form was given to doctors at a later stage in the control arm for them to amend prescriptions. The effect of the intervention was assessed primarily by comparing the number of patients having at least 1 admission medication discrepancy regarding medication being taken at home. Secondary outcomes concerned the characteristics and clinical severity of such medication discrepancies.

Results

The intervention reduced discrepancies occurring by 33% (p < 0.0001; 0.1055 odds ratio, 0.05-0.24 95% confidence interval), despite recall bias. Regarding total discrepancies, omitting medication occurred most frequently (55.1%) and most discrepancies (42.7%) were judged to have the potential to cause moderate discomfort or clinical deterioration.

Conclusions

A pharmacist-acquired medication history in an ED focusing on a patient’s current home medication regimen available to be used by a doctor at the time of consulting in the ED reduced the number of patients having at least 1 home medication-related discrepancy.

Trial registration

Current Controlled Trials ISRCTN63455839.