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An evaluation of medication reconciliation at an outpatient Internal Medicines clinic
EJINME-03609; No of Pages 3 European Journal of Internal Medicine xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim
Letter to the Editor An evaluation of medication reconciliation at an outpatient Internal Medicines clinic Keywords: Medication reconciliation Outpatient clinic Internal medicine Patient knowledge Patient satisfaction
Incomplete information transfer between healthcare settings could result in discontinuity in healthcare. Discrepancies between a patient's actual medication use and the medication that is listed in a patient's record are an important example [1–5]. Ashjian et al. showed that 88% of patients have one or more discrepancies in the outpatient setting [6]. Medication reconciliation can resolve unintentional discrepancies in up to 98% of patients [7]. However, medication reconciliation is not implemented broadly in the outpatient setting. Therefore, we evaluated the impact of medication reconciliation on identifying discrepancies at an outpatient Internal Medicines clinic. Also, the effect on the physician's time to discuss medication-related topics was assessed. Finally, patients' knowledge about medication changes and patients' satisfaction was evaluated. A prospective study was conducted between February 2015 and July 2015 at a 550-bed general teaching hospital in the Netherlands (OLVG). Adult patients (N18 years of age) visiting the outpatient clinic of the Department of Internal Medicine were included if the patient used more than one drug chronically during at least three months. In the usual care group, structured medication reconciliation was not implemented. Treating physicians interviewed patients to verify their actual medication use and updated their electronic medication records when considered necessary. For the intervention group, a pharmacy team contacted the community pharmacy to assess the prescriptions that had been dispensed in the previous six months (in the Netherlands, the medication history of community pharmacies are relatively complete as patients generally visit one community pharmacy). Patients or carers were called one week before the visit to the outpatient department using a protocol. Patients were interviewed regarding their actual medication use (drug name, dosage, administration route and frequency), including the use of over-the-counter (OTC) products. The information from this interview was compared with the medication history from the community pharmacy and the hospital's medication records. Reasons for discrepancies between actual medication use and the listed medication were clarified with the patient. To extract the time that the physician needed to discuss drug-related topics and to assess which medication changes were implemented patients' clinic visits in the usual and intervention group were tape recorded. To assess unintentional discrepancies, the patients in both groups were telephoned within one week after the outpatient visit. Patients
were asked to have their medication boxes in front of them and were interviewed again. The patient's actual medication use was compared with the medication list of the physician at the moment of the outpatient visit. Discrepancies were classified into 4 mutually exclusive categories: omission (when a patient used a drug that was absent in the hospital records), commission (when a patient did not use a drug anymore), dosage (differences in dosage or frequency) and switch (a difference in the same drug category). During the interview, patients were also asked to specify which changes were made during the clinic visit. This information was compared with the information extracted from the tape recording and the hospital records. The knowledge of the patient regarding medication changes was classified as correct when a patient could recall the name, dose and frequency of each changed drug. To assess patients' satisfaction with communication regarding drugs and - for the intervention group - the medication reconciliation service, patients were requested to fill out a questionnaire after the outpatient visit. A total of 420 patients were assessed for eligibility. 308 patients were included: 157 in the usual care group and 151 in the intervention group. The main reasons for exclusion were no chronic drug use and lack of informed consent. The mean age of patients was 63 years (p = 0.156, Table 1). There was no significant difference in gender (p = 0.199) and the proportion of patients with a medication change (p = 0.460). Significant differences were observed as more patients in the intervention group worked (36% versus 23%, p = 0.009), had a lower education level (p = 0.007) and used less drugs (p b 0.0001). The proportion of patients with an unintentional discrepancy decreased from 83% (n = 131) to 39% (n = 59) in the intervention group (p b 0.0001, Table 2). The OR was 0.14 (CI: 0.08–0.25) after adjusting for the baseline differences in the number of medicines, education, and working status of patients. The number of discrepancies per patient decreased significantly with a mean of 3.5 (SD 3.5) discrepancies per patient in the usual care group to 0.7 (SD 1.4) in the intervention group (p b 0.0001). Especially, the proportion of patients with multiple discrepancies decreased by 44.3% in the intervention group. In both groups 79 medication changes were initiated during the outpatient visit with dose/frequency changes being most common. The proportion of patients that correctly recalled the medication change increased from 70.9% to 83.5% after the intervention (p = 0.058, adjusted OR: 1.35, CI: 0.55–3.28). Physicians spent a median of 49 s to discuss drug-related topics, i.e. 11.6% and 8.7% of the total consultation time for the control and intervention group, respectively (p = 0.316). Examples of drug-related topics were the inventory of the drugs a patient used, the efficacy of drugs, side effects, how to use the drugs and the need for repeat prescriptions. The mean satisfaction rates with the physician's communication regarding drugs did not differ between groups (p = 0.687). Of all patients in the intervention group 87.4% responded positively to the medication reconciliation service as they stated that they understood the importance of clarifying the medication use.
http://dx.doi.org/10.1016/j.ejim.2017.07.015 0953-6205/© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Please cite this article as: van der Gaag S, et al, An evaluation of medication reconciliation at an outpatient Internal Medicines clinic, Eur J Intern Med (2017), http://dx.doi.org/10.1016/j.ejim.2017.07.015
2
Letter to the Editor
Table 1 Clinical characteristics of usual care group (n = 157) and intervention group (n = 151). Patient characteristics
Usual care (n = 157)
Intervention (n = 151)
p-Value
Male, n (%) Age (years), mean ± SD Living status Alone, n (%) Together, n (%) Work status Work, n (%) Unemployed, n (%) Education None/primary education, n (%) Secondary education, n (%) Higher professional education/university, n (%) Language restrictions, n (%) No. of medicines, mean ± SD Help with medication use No, n (%) Yes, n (%) Medication management Medication in boxes, n (%) Use of weekly compliance aid, n (%) Medication changed during out patient visit, n (%)a Start of new medication, n (%) Stop, n (%) Dose-/frequency change, n (%) Switch, n (%)
79 (50.3) 63.8 ± 15.4
87 (57.6) 61.3 ± 15.3
0.199 0.156 0.600
67 (42.7) 90 (57.3)
60 (39.7) 91 (60.3)
36 (22.9) 121 (77.1)
55 (36.4) 96 (63.6)
44 (28.0) 84 (53.5) 29 (18.5)
58 (38.4) 54 (35.8) 39 (25.8)
30 (19.1) 9.0 ± 4.9
20 (13.2) 7.1 ± 4.3
144 (91.7) 13 (8.3)
143 (94.7) 8 (5.3)
124 (79.0) 33 (21.0) 57 (36.3)
131 (86.8) 20 (13.2) 61 (40.4)
21 (13.4) 16 (10.2) 29 (18.5) 4 (2.5)
17 (11.3) 12 (7.9) 38 (25.2) 3 (2.0)
0.009
0.007
0.163 b0.0001 0.299
0.071
0.460
The bold represents the significant p-values in the table. It shows which characteristics differ significantly between the usual care group and the intervention group. a Some patients had multiple changes.
In this study we showed a decrease in discrepancies between a patient's actual medication use and the medication listed in het hospital's records from 83% to 39%. In the intervention group discrepancies were still present because patients forgot to tell the pharmacy team about drugs that were also used, such as creams, ointments or vitamins. It is possible that the second medication reconciliation triggered patients to include these drugs as well. A systematic review of Bayoumi et al. showed large variations in different studies where one study showed no benefit of medication reconciliation and another study showed a decrease of discrepancies from 88.5% to 49.1% [8,9]. These results are in line with the decrease found in this study. Similar reductions were reported by Nassaralla et al. where discrepancies decreased from
Table 2 Number and type of discrepancies between actual and documented medication use in the usual care group and the intervention group.
Patients with any discrepancy Omission, n (%) Dosage, n (%) Switch, n (%) Commission, n (%) Discrepancies per patient, mean ± SD 1–2, n (%) 3–4, n (%) 5–6, n (%) ≥7, n (%)
Usual care (n = 157)
Intervention (n = 151)
p-Value
131 (83.4) 107 (68.2) 61 (38.9) 16 (10.2) 62 (39.5) 3.5 ± 3.5 49 (31.2) 37 (23.6) 21 (13.4) 24 (15.3)
59 (39.1) 23 (15.2) 15 (9.9) 4 (2.6) 31 (20.5) 0.7 ± 1.4 50 (33.1) 5 (3.3) 2 (1.3) 2 (1.3)
b0.0001
b0.0001
The bold represents the significant p-values in the table. It shows which characteristics differ significantly between the usual care group and the intervention group.
90% of patients to 29% [10]. Differences in the effect of medication reconciliation may be caused by differences in patients groups. Strength of this study was the structural basis on which interviews about actual medication use were performed using a protocol. There were also some limitations to this study. Firstly, many patients were non- or low educated and this study was conducted in one hospital, thereby limiting the generalizability. Secondly, we only determined the number of discrepancies and not the clinical impact of these discrepancies. It is obvious that an omission of vitamins or acetaminophen has less clinical impact than omission of for example cardiovascular drugs. Thirdly, 11.4% of outpatient visits were not tape recorded. This could result in an undervaluation of medication changes. However, patients did not indicate that more drugs were changed during the telephone interview. Some recommendations can be made for further research. Firstly, the time used by the physician should be measured after medication reconciliation has become standard practice. It is expected that the time savings for the physician will increase as they will not spent time on the inventory of drugs anymore. Secondly, other efficient ways of medication reconciliation should be further explored, such as the use of patient portals. At last, future studies must investigate the clinical impact of various discrepancies on actual ADE's. In conclusion, medication reconciliation at an outpatient clinic of the Department of Internal Medicines decreases unintentional discrepancies between the actual medication use and the medication reported in the hospital's medication record. Also, a non-significant increase was observed in patients' knowledge of medication changes. In this study, no difference was noted for the time the physician needed to discuss drug-related topics. Patients were satisfied with the medication reconciliation service. Competing interest The authors declare that they have no conflict of interest. Acknowledgements We would like to express our gratitude to the pharmacy team, the patients and the community pharmacies for their efforts and cooperation.
References [1] Neufeld NJ, Gonzalez Fernandez M, Christo PJ, et al. Positive recognition program increases compliance with medication reconciliation by resident physicians in an outpatient clinic. Am J Med Qual 2013;28(1):40–5. [2] Peyton L, Ramser K, Hamann G, et al. Evaluation of medication reconciliation in an ambulatory setting before and after pharmacist intervention. J Am Pharm Assoc 2010;50:490–5. [3] Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 2005;164: 424–9. [4] Moore C, Wisnivesky J, Williams S, et al. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med 2003;18(8): 646–51. [5] Taché SV, Sönnichsen A, Ashcroft DM. Prevalence of adverse drug events in ambulatory care: a systematic review. Ann Pharmacother 2011;45:977–89. [6] Ashjian E, Salamin LB, Eschenburg K, et al. Evaluation of outpatient medication reconciliation involving student pharmacists at a comprehensive cancer centre. J Am Pharm Assoc 2015;55(5):540–5. [7] Lehnbom EC, Stewart MJ, Manias E, et al. Impact of medication reconciliation and review on clinical outcomes. Ann Pharmacother 2014;48(10):1298–312. [8] Varkey P, Cunningham J, Bisping S. Improving medication reconciliation in the outpatient setting. Jt Comm J Qual Improv 2007;33(5):286–92. [9] Bayoumi I, Howard M, Holbrook AM, et al. Interventions to improve medication reconciliation in primary care. Ann Pharmacother 2009;43:1667–75. [10] Nassaralla CL, Naessens JM, Chaudhry R, et al. Implementation of a medication reconciliation process in an ambulatory internal medicine clinic. Qual Saf Health Care 2007;16:90–4.
Please cite this article as: van der Gaag S, et al, An evaluation of medication reconciliation at an outpatient Internal Medicines clinic, Eur J Intern Med (2017), http://dx.doi.org/10.1016/j.ejim.2017.07.015
Letter to the Editor
Suzanne van der Gaag Marjo J.A. Janssen Hanneke Wessemius OLVG Hospital, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands E-mail addresses: [email protected] (S. van der Gaag), [email protected] (M.J.A. Janssen), [email protected] (H. Wessemius).
3
Fatma Karapinar-Çarkit⁎ OLVG Hospital, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands ⁎Corresponding author. E-mail address: [email protected]. 20 June 2017 Available online xxxx
Carl E.H. Siegert OLVG Hospital, Department of Internal Medicine, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands E-mail address: [email protected].
Please cite this article as: van der Gaag S, et al, An evaluation of medication reconciliation at an outpatient Internal Medicines clinic, Eur J Intern Med (2017), http://dx.doi.org/10.1016/j.ejim.2017.07.015
Contents lists available at ScienceDirect
European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim
Letter to the Editor An evaluation of medication reconciliation at an outpatient Internal Medicines clinic Keywords: Medication reconciliation Outpatient clinic Internal medicine Patient knowledge Patient satisfaction
Incomplete information transfer between healthcare settings could result in discontinuity in healthcare. Discrepancies between a patient's actual medication use and the medication that is listed in a patient's record are an important example [1–5]. Ashjian et al. showed that 88% of patients have one or more discrepancies in the outpatient setting [6]. Medication reconciliation can resolve unintentional discrepancies in up to 98% of patients [7]. However, medication reconciliation is not implemented broadly in the outpatient setting. Therefore, we evaluated the impact of medication reconciliation on identifying discrepancies at an outpatient Internal Medicines clinic. Also, the effect on the physician's time to discuss medication-related topics was assessed. Finally, patients' knowledge about medication changes and patients' satisfaction was evaluated. A prospective study was conducted between February 2015 and July 2015 at a 550-bed general teaching hospital in the Netherlands (OLVG). Adult patients (N18 years of age) visiting the outpatient clinic of the Department of Internal Medicine were included if the patient used more than one drug chronically during at least three months. In the usual care group, structured medication reconciliation was not implemented. Treating physicians interviewed patients to verify their actual medication use and updated their electronic medication records when considered necessary. For the intervention group, a pharmacy team contacted the community pharmacy to assess the prescriptions that had been dispensed in the previous six months (in the Netherlands, the medication history of community pharmacies are relatively complete as patients generally visit one community pharmacy). Patients or carers were called one week before the visit to the outpatient department using a protocol. Patients were interviewed regarding their actual medication use (drug name, dosage, administration route and frequency), including the use of over-the-counter (OTC) products. The information from this interview was compared with the medication history from the community pharmacy and the hospital's medication records. Reasons for discrepancies between actual medication use and the listed medication were clarified with the patient. To extract the time that the physician needed to discuss drug-related topics and to assess which medication changes were implemented patients' clinic visits in the usual and intervention group were tape recorded. To assess unintentional discrepancies, the patients in both groups were telephoned within one week after the outpatient visit. Patients
were asked to have their medication boxes in front of them and were interviewed again. The patient's actual medication use was compared with the medication list of the physician at the moment of the outpatient visit. Discrepancies were classified into 4 mutually exclusive categories: omission (when a patient used a drug that was absent in the hospital records), commission (when a patient did not use a drug anymore), dosage (differences in dosage or frequency) and switch (a difference in the same drug category). During the interview, patients were also asked to specify which changes were made during the clinic visit. This information was compared with the information extracted from the tape recording and the hospital records. The knowledge of the patient regarding medication changes was classified as correct when a patient could recall the name, dose and frequency of each changed drug. To assess patients' satisfaction with communication regarding drugs and - for the intervention group - the medication reconciliation service, patients were requested to fill out a questionnaire after the outpatient visit. A total of 420 patients were assessed for eligibility. 308 patients were included: 157 in the usual care group and 151 in the intervention group. The main reasons for exclusion were no chronic drug use and lack of informed consent. The mean age of patients was 63 years (p = 0.156, Table 1). There was no significant difference in gender (p = 0.199) and the proportion of patients with a medication change (p = 0.460). Significant differences were observed as more patients in the intervention group worked (36% versus 23%, p = 0.009), had a lower education level (p = 0.007) and used less drugs (p b 0.0001). The proportion of patients with an unintentional discrepancy decreased from 83% (n = 131) to 39% (n = 59) in the intervention group (p b 0.0001, Table 2). The OR was 0.14 (CI: 0.08–0.25) after adjusting for the baseline differences in the number of medicines, education, and working status of patients. The number of discrepancies per patient decreased significantly with a mean of 3.5 (SD 3.5) discrepancies per patient in the usual care group to 0.7 (SD 1.4) in the intervention group (p b 0.0001). Especially, the proportion of patients with multiple discrepancies decreased by 44.3% in the intervention group. In both groups 79 medication changes were initiated during the outpatient visit with dose/frequency changes being most common. The proportion of patients that correctly recalled the medication change increased from 70.9% to 83.5% after the intervention (p = 0.058, adjusted OR: 1.35, CI: 0.55–3.28). Physicians spent a median of 49 s to discuss drug-related topics, i.e. 11.6% and 8.7% of the total consultation time for the control and intervention group, respectively (p = 0.316). Examples of drug-related topics were the inventory of the drugs a patient used, the efficacy of drugs, side effects, how to use the drugs and the need for repeat prescriptions. The mean satisfaction rates with the physician's communication regarding drugs did not differ between groups (p = 0.687). Of all patients in the intervention group 87.4% responded positively to the medication reconciliation service as they stated that they understood the importance of clarifying the medication use.
http://dx.doi.org/10.1016/j.ejim.2017.07.015 0953-6205/© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Please cite this article as: van der Gaag S, et al, An evaluation of medication reconciliation at an outpatient Internal Medicines clinic, Eur J Intern Med (2017), http://dx.doi.org/10.1016/j.ejim.2017.07.015
2
Letter to the Editor
Table 1 Clinical characteristics of usual care group (n = 157) and intervention group (n = 151). Patient characteristics
Usual care (n = 157)
Intervention (n = 151)
p-Value
Male, n (%) Age (years), mean ± SD Living status Alone, n (%) Together, n (%) Work status Work, n (%) Unemployed, n (%) Education None/primary education, n (%) Secondary education, n (%) Higher professional education/university, n (%) Language restrictions, n (%) No. of medicines, mean ± SD Help with medication use No, n (%) Yes, n (%) Medication management Medication in boxes, n (%) Use of weekly compliance aid, n (%) Medication changed during out patient visit, n (%)a Start of new medication, n (%) Stop, n (%) Dose-/frequency change, n (%) Switch, n (%)
79 (50.3) 63.8 ± 15.4
87 (57.6) 61.3 ± 15.3
0.199 0.156 0.600
67 (42.7) 90 (57.3)
60 (39.7) 91 (60.3)
36 (22.9) 121 (77.1)
55 (36.4) 96 (63.6)
44 (28.0) 84 (53.5) 29 (18.5)
58 (38.4) 54 (35.8) 39 (25.8)
30 (19.1) 9.0 ± 4.9
20 (13.2) 7.1 ± 4.3
144 (91.7) 13 (8.3)
143 (94.7) 8 (5.3)
124 (79.0) 33 (21.0) 57 (36.3)
131 (86.8) 20 (13.2) 61 (40.4)
21 (13.4) 16 (10.2) 29 (18.5) 4 (2.5)
17 (11.3) 12 (7.9) 38 (25.2) 3 (2.0)
0.009
0.007
0.163 b0.0001 0.299
0.071
0.460
The bold represents the significant p-values in the table. It shows which characteristics differ significantly between the usual care group and the intervention group. a Some patients had multiple changes.
In this study we showed a decrease in discrepancies between a patient's actual medication use and the medication listed in het hospital's records from 83% to 39%. In the intervention group discrepancies were still present because patients forgot to tell the pharmacy team about drugs that were also used, such as creams, ointments or vitamins. It is possible that the second medication reconciliation triggered patients to include these drugs as well. A systematic review of Bayoumi et al. showed large variations in different studies where one study showed no benefit of medication reconciliation and another study showed a decrease of discrepancies from 88.5% to 49.1% [8,9]. These results are in line with the decrease found in this study. Similar reductions were reported by Nassaralla et al. where discrepancies decreased from
Table 2 Number and type of discrepancies between actual and documented medication use in the usual care group and the intervention group.
Patients with any discrepancy Omission, n (%) Dosage, n (%) Switch, n (%) Commission, n (%) Discrepancies per patient, mean ± SD 1–2, n (%) 3–4, n (%) 5–6, n (%) ≥7, n (%)
Usual care (n = 157)
Intervention (n = 151)
p-Value
131 (83.4) 107 (68.2) 61 (38.9) 16 (10.2) 62 (39.5) 3.5 ± 3.5 49 (31.2) 37 (23.6) 21 (13.4) 24 (15.3)
59 (39.1) 23 (15.2) 15 (9.9) 4 (2.6) 31 (20.5) 0.7 ± 1.4 50 (33.1) 5 (3.3) 2 (1.3) 2 (1.3)
b0.0001
b0.0001
The bold represents the significant p-values in the table. It shows which characteristics differ significantly between the usual care group and the intervention group.
90% of patients to 29% [10]. Differences in the effect of medication reconciliation may be caused by differences in patients groups. Strength of this study was the structural basis on which interviews about actual medication use were performed using a protocol. There were also some limitations to this study. Firstly, many patients were non- or low educated and this study was conducted in one hospital, thereby limiting the generalizability. Secondly, we only determined the number of discrepancies and not the clinical impact of these discrepancies. It is obvious that an omission of vitamins or acetaminophen has less clinical impact than omission of for example cardiovascular drugs. Thirdly, 11.4% of outpatient visits were not tape recorded. This could result in an undervaluation of medication changes. However, patients did not indicate that more drugs were changed during the telephone interview. Some recommendations can be made for further research. Firstly, the time used by the physician should be measured after medication reconciliation has become standard practice. It is expected that the time savings for the physician will increase as they will not spent time on the inventory of drugs anymore. Secondly, other efficient ways of medication reconciliation should be further explored, such as the use of patient portals. At last, future studies must investigate the clinical impact of various discrepancies on actual ADE's. In conclusion, medication reconciliation at an outpatient clinic of the Department of Internal Medicines decreases unintentional discrepancies between the actual medication use and the medication reported in the hospital's medication record. Also, a non-significant increase was observed in patients' knowledge of medication changes. In this study, no difference was noted for the time the physician needed to discuss drug-related topics. Patients were satisfied with the medication reconciliation service. Competing interest The authors declare that they have no conflict of interest. Acknowledgements We would like to express our gratitude to the pharmacy team, the patients and the community pharmacies for their efforts and cooperation.
References [1] Neufeld NJ, Gonzalez Fernandez M, Christo PJ, et al. Positive recognition program increases compliance with medication reconciliation by resident physicians in an outpatient clinic. Am J Med Qual 2013;28(1):40–5. [2] Peyton L, Ramser K, Hamann G, et al. Evaluation of medication reconciliation in an ambulatory setting before and after pharmacist intervention. J Am Pharm Assoc 2010;50:490–5. [3] Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 2005;164: 424–9. [4] Moore C, Wisnivesky J, Williams S, et al. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med 2003;18(8): 646–51. [5] Taché SV, Sönnichsen A, Ashcroft DM. Prevalence of adverse drug events in ambulatory care: a systematic review. Ann Pharmacother 2011;45:977–89. [6] Ashjian E, Salamin LB, Eschenburg K, et al. Evaluation of outpatient medication reconciliation involving student pharmacists at a comprehensive cancer centre. J Am Pharm Assoc 2015;55(5):540–5. [7] Lehnbom EC, Stewart MJ, Manias E, et al. Impact of medication reconciliation and review on clinical outcomes. Ann Pharmacother 2014;48(10):1298–312. [8] Varkey P, Cunningham J, Bisping S. Improving medication reconciliation in the outpatient setting. Jt Comm J Qual Improv 2007;33(5):286–92. [9] Bayoumi I, Howard M, Holbrook AM, et al. Interventions to improve medication reconciliation in primary care. Ann Pharmacother 2009;43:1667–75. [10] Nassaralla CL, Naessens JM, Chaudhry R, et al. Implementation of a medication reconciliation process in an ambulatory internal medicine clinic. Qual Saf Health Care 2007;16:90–4.
Please cite this article as: van der Gaag S, et al, An evaluation of medication reconciliation at an outpatient Internal Medicines clinic, Eur J Intern Med (2017), http://dx.doi.org/10.1016/j.ejim.2017.07.015
Letter to the Editor
Suzanne van der Gaag Marjo J.A. Janssen Hanneke Wessemius OLVG Hospital, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands E-mail addresses: [email protected] (S. van der Gaag), [email protected] (M.J.A. Janssen), [email protected] (H. Wessemius).
3
Fatma Karapinar-Çarkit⁎ OLVG Hospital, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands ⁎Corresponding author. E-mail address: [email protected]. 20 June 2017 Available online xxxx
Carl E.H. Siegert OLVG Hospital, Department of Internal Medicine, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands E-mail address: [email protected].
Please cite this article as: van der Gaag S, et al, An evaluation of medication reconciliation at an outpatient Internal Medicines clinic, Eur J Intern Med (2017), http://dx.doi.org/10.1016/j.ejim.2017.07.015