European Journal of Clinical Pharmacology

, Volume 67, Issue 7, pp 741–752 | Cite as

Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

  • Lina M. Hellström
  • Åsa Bondesson
  • Peter Höglund
  • Patrik Midlöv
  • Lydia Holmdahl
  • Eva Rickhag
  • Tommy Eriksson
Pharmacoepidemiology and Prescription



To examine the impact of systematic medication reconciliations upon hospital admission and of a medication review while in hospital on the number of inappropriate medications and unscheduled drug-related hospital revisits in elderly patients.


This was a prospective, controlled study in 210 patients, aged 65 years or older, who were admitted to one of three internal medicine wards at a University Hospital in Sweden. Intervention patients received the complete Lund Integrated Medicines Management model (medication reconciliation upon admission and discharge, and medication review and monitoring) provided by a multi-professional team, including a clinical pharmacist. Control patients received standard care and medication reconciliation upon discharge. Blinded reviewers evaluated the appropriateness of the prescribing (using the Medication Appropriateness Index) on admission and discharge, and assessed the probability that a drug-related problem was the reason for any patient readmitted to hospital or visiting the emergency department within 3 months of discharge (using World Health Organisation causality criteria).


There was a greater decrease in the number of inappropriate drugs in the intervention group than in the control group for both the intention-to-treat population {51% [95% confidence interval (CI) 43–58%] vs. 39% (95% CI 30–48%); p = 0.0446} and the per-protocol population [60% (95% CI 51–67%) vs. 44% (95% CI 34–52%); p = 0.0106)]. There were six revisits to hospital in the intervention group which were judged as ‘possibly, probably or certainly drug-related’, compared with 12 in the control group (p = 0.0469).


In this study, medication reconciliation and review provided by a clinical pharmacist in a multi-professional team significantly reduced the number of inappropriate drugs and unscheduled drug-related hospital revisits among elderly patients.


Clinical pharmacy services Medication Appropriateness Index Medication review Medication reconciliation Drug-related problems Inpatients 



We thank the pharmacists Tanja Lehtinen and Lily Esporlas for their skillful help with the collection and evaluation of data, all staff of the study wards and the clinical pharmacists involved who were members of the team. The contribution of the Hospital pharmacy, Skåne University Hospital, Lund, employer of Lina Hellström, Åsa Bondesson and Eva Rickhag at the time of the study, is gratefully acknowledged. Finally, we thank the employer of Lina Hellström, Åsa Bondesson and Eva Rickhag at the time of the study, the Hospital Pharmacy, Skåne University Hospital, for giving us the opportunity to perform the study.

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Lina M. Hellström
    • 1
  • Åsa Bondesson
    • 4
  • Peter Höglund
    • 2
  • Patrik Midlöv
    • 5
    • 6
  • Lydia Holmdahl
    • 7
  • Eva Rickhag
    • 7
  • Tommy Eriksson
    • 2
    • 3
  1. 1.eHealth Institute and School of Natural SciencesLinnaeus UniversityKalmarSweden
  2. 2.Department of Clinical PharmacologyLund UniversityLundSweden
  3. 3.Apoteket Farmaci ABLundSweden
  4. 4.County of Skåne, Department of Medicines Management and InformaticsMalmöSweden
  5. 5.Department of Clinical Sciences in Malmö, General Practice/Family MedicineLund UniversityLundSweden
  6. 6.Centre for Primary Health Care ResearchLund UniversityLundSweden
  7. 7.Department of MedicineSkåne University HospitalLundSweden

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