Development of Medication Reconciliation Using Electronic Pharmaceutical Record: a National Multicenter, Cluster-randomized, Two-period Crossover Study in Elderly Hospitalized in Geriatrics, Internal Medicine and Orthopedic Surgery

Context Adverse drug events (ADEs) may occur in community or hospitalized patients. A review of the literature reports an incidence of ADEs varying from 0.1 to 61.4 %. This wide range may be explained by different designs and case-mix in the studies. For instance, the incidence of ADEs is higher in surgical wards or in the elderly, and increases with the number of prescribed drugs. In the elderly, the risk of ADE has been reported as 2-fold higher than that of a younger population. Some ADEs may not have been prevented, for example when the event was associated with an intended or known effect (e.g. neutropenia after cytotoxic drugs administration). However, some other ADEs might have been prevented whenever they were related to medications errors (omission, commission, dosing errors, prescription despite known allergies...). The proportion of preventable ADEs has been reported to range from 25% to 43% of total ADEs.

ADE can lead to extra monitoring because of biological abnormalities but also in more serious cases, to temporary or permanent harms, and even to death.

Prolonged hospitalizations are also attributed to ADE. Gastrointestinal tract events are the most common type of ADEs, followed by electrolyte and renal events, hemorrhages, metabolic and endocrine events. Drugs involved are cardiovascular drugs, followed by analgesics, antibiotics and anticoagulants.

Discrepancies between patient's current medication and the drugs prescribed at hospital admission hospital are frequent (27 to 54%) and have been reported in numerous studies. Potential consequences of such discrepancies have been extensively studied but data dealing with clinical outcomes are sparse.

Medication reconciliation is a process aiming at the creation of the most appropriate list of patient's medications, thus decreasing medication discrepancies and eventually ADE. Medication reconciliation can be performed by physicians, nurses, pharmacists. Usual sources of information for medication reconciliation are patient's prescriptions from the attending physician, patient's interview, hospital records... Additionally, information technology and electronic health records are of great help in this process. In France, drugs dispensed to a patient in community pharmacies during the 4 past months are registered in his/her electronic pharmaceutical record which is available to any pharmacist nationwide. This database is protected and can be consulted after recognition of the patient's healthcare card. To date, the contribution of this record to medication reconciliation has not been studied. The CONCIPAGE study will estimate the impact of a medication reconciliation using patient pharmaceutical record, on the occurrence of ADEs during the hospitalization of patients aged 65 years and over.