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Usually available clinical and laboratory data are insufficient for a valid medication review: A crossover study

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The journal of nutrition, health & aging

Abstract

Objectives

To establish the quality of medication reviews performed by nursing home physicians, general practitioners and pharmacists.

Design and setting

15 Pharmacists, 13 general practitioners and 18 nursing home physicians performed a medication review for three cases (A, B and C), at three evaluation moments. First, they received the medication list. Secondly, they also received laboratory results and reason for admission and finally, we added medical history. Remarks were divided into 6 categories, i.e. indication without medication, medication without indication, contraindications/ interactions, dosage problems, double medication and wrong medication. Remarks were compared to the remarks made by our expert panel and scored according to our grading model as appropriate (0 to +3) or missed or potentially harmful (-1). For each medication error category, the percentage of participants who made this error was computed.

Results

After the first evaluation moment, the overall estimated mean percentage score was -1.7% for case A, 3.9% for case B, and 8.7% for case C. After the second review, this score was 15.0% for case A, 19.8% for case B, and 22.2% for case C. This further increased to 30.0% for case A, 36.7% for case B and 44% for case C at the final evaluation. The absence of medication where there was an indication (indication without medication) was frequently missed and did not improve after adding the extra information regarding laboratory results, reason for admission and finally medical history.

Conclusion

Increasing clinical information helps physicians and pharmacists to improve their medication reviews, however, additional information was still related with a high margin of error. Detection of certain errors becomes easier with additional information, whereas other errors remain undetected. To achieve a high standard of medication review, we have to change the way medication reviews should be performed.

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Centre, PO box 22660, Amsterdam, the Netherlands

    Kim P.G.M. Hurkens

  2. Department of Clinical Pharmacology, Orbis Medical Centre, PO box 5500, Sittard, the Netherlands

    C. Mestres-Gonzalvo, P.H.M. Van Der Kuy & R. Janknegt

  3. Department of Clinical Pharmacy and Toxicology, Atrium Medical Centre, PO box 4446, Heerlen, the Netherlands

    H.A.J.M. De Wit

  4. Alzheimer Centre Limburg, School of Mental Health and Neuroscience, Maastricht University Medical Centre, PO box 5800, Maastricht, the Netherlands

    F. Verhey

  5. Department of Family Medicine and Department Health Services Research, Maastricht University Medical Centre, PO box 616, 6200, MD Maastricht, the Netherlands

    J.M.G.A. Schols

  6. Department of Internal Medicine, Maastricht University Medical Centre, PO box 5800, Maastricht, the Netherlands

    C.D.A. Stehouwer & W. Mulder

  7. Department of Methodology and Statistics, Maastricht University Medical Centre, PO box 616, 6200, MD Maastricht, the Netherlands

    B. Winkens

  8. Cardiovasculair Research Institute Maastricht (CARIM), Maastricht University Medical Centre, PO box 5800, Maastricht, the Netherlands

    C.D.A. Stehouwer

  9. School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, PO box 616, 6200, MD Maastricht, the Netherlands

    J.M.G.A. Schols & B. Winkens

Authors
  1. Kim P.G.M. Hurkens
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  2. C. Mestres-Gonzalvo
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  3. H.A.J.M. De Wit
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  4. P.H.M. Van Der Kuy
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  7. J.M.G.A. Schols
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  8. C.D.A. Stehouwer
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Corresponding author

Correspondence to Kim P.G.M. Hurkens.

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Hurkens, K., Mestres-Gonzalvo, C., De Wit, H. et al. Usually available clinical and laboratory data are insufficient for a valid medication review: A crossover study. J Nutr Health Aging 20, 71–76 (2016). https://doi.org/10.1007/s12603-016-0678-1

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  • DOI: https://doi.org/10.1007/s12603-016-0678-1

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