Medication reconciliation in a hospital environment: Avoided discrepancies and cost savings - A single arm intervention study: Benefits of medication reconciliation in a hospitalAbstract
Medication reconciliation has proven to be essential for patient safety. However, studies on its economic viability are still scarce. Therefore, the aim of this study was to understand the avoided cost of medication discrepancies identified through the medication reconciliation service at the hospital level. Single-arm intervention study, linked to the evaluation of return on investment. Patients admitted to a hospital from March to August 2020, who underwent a medication reconciliation service, were included. With regard to medication reconciliation, in the 102 pharmaceutical admissions of patients participating in the study, 62 discrepancies were found, being 37 (59.7 %) unintentional and 25 (40.3 %) intentional. A total of 49.0 % of interventions were accepted or partially accepted by the prescriber. The suggestion to include medication used at home in the prescription represented 78.0 % of the interventions. The total cost avoided from pharmaceutical interventions in unintentional discrepancies over the 60-day period was R$9,406.59 (US$1,802.03). A high number of unintentional discrepancies in hospital prescriptions was observed. The role of the pharmacist in reconciling medication has a relatively low cost compared to their relevant role in preventing errors and avoiding costs.
Keywords:
Cost savings; Economics; Pharmaceutical; Investments; Medication reconciliation.
Impact statements
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The number of discrepancies in the analyzed hospital prescriptions was very high, which can have disastrous consequences for the patients.
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The cost of the clinical pharmacist was very low compared to the error prevention.
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Medication reconciliation can considerably avoid costs in the hospital environment by preventing possible errors resulting from the omission of the history of medication used at home.
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The clinical pharmacist can contribute to the effectiveness and safety of pharmacological therapy in the hospital environment, by carrying out medication reconciliation.
INTRODUCTION
Medication therapy plays an essential role in health care, being one of the most cost-effective therapeutic resources available. However, the complexity of medication use and the pharmacotherapeutic management process, especially in hospitalized patients, can result in adverse events and considerable risks to the safety of these patients (Medeiros, Santos, 2019).
Among adverse medication events, medication errors represent those with the highest occurrence in hospitals, being multidisciplinary in nature, and have been considered a serious public health problem worldwide (Mieiro et al., 2019) Errors resulting from failures in prescriptions are among the main causes of complications, which may reduce the effectiveness of treatment or increase the risk of injury to the patient (Pimenta et al., 2019).
In this sense, to offer safe assistance to users, health institutions must develop strategies aimed at activities that include medication, requiring the work of a multidisciplinary team in the search for the development of safe services and good communication between professionals to reduce the chances of error in the medication process (Mieiro et al., 2019; Silva et al., 2022).
Patients undergoing treatments that require complex medication regimens, who have chronic diseases, and those who constantly need hospitalization, can benefit from pharmaceutical care, with emphasis on medication reconciliation (Silva et al., 2022).
Medication reconciliation is a pharmaceutical clinical service that aims to avoid unnecessary harm to the patient by preventing medication errors resulting from discrepancies in pharmacotherapy, such as duplications or omissions of medication (WHO, 2017). The service can be described as a formal process of obtaining the most complete list possible of all medication used by the patient at home, and the continuous evaluation of this list. In addition, it aims to ensure that in all transitions from one health care sector to another, information about their medication is transferred at the same time in a complete and detailed way (ISMP, 2017; Fontoura, 2019).
Medication reconciliation can be considered a simple process, but in order to be carried out effectively, it must be carried out in phases starting with the patient’s admission through a pharmaceutical anamnesis (Anazi, 2021). Medication reconciliation makes it possible to identify medication discrepancies by comparing the data collected by the pharmacist upon admission, and during the anamnesis, with the prescription made by the doctor based on a pharmaceutical intervention. The pharmaceutical intervention can be described as an act planned, documented, and carried out with the patient and health professionals, with the aim of solving or preventing problems that interfere or may interfere with pharmacotherapy. Through pharmaceutical intervention, it is possible to intercept and rectify cases of differences found, and adapt medication treatment with the prescriber (Dorneles et al., 2020).
In this context, the implementation of the medication reconciliation service plays an important role in reducing errors, as it helps to identify the patient's continuous use medication and analyze possible discrepancies in the transition (WHO, 2017).
In view of the above, the implementation of clinical practices involved in the medication reconciliation service becomes essential through the insertion of the pharmaceutical professional (Baldoni et al., 2016), and in this scenario it is essential that the impact of pharmaceutical services is measured (CFF, 2017). Despite the existence of studies with cost estimates of pharmaceutical interventions (Oliveira et al., 2023), there are still few studies that assess the economic viability of medication reconciliation (Park et al., 2022). Furthermore, it becomes relevant to propose a standardized medication reconciliation strategy considering the scenario of adverse events in the hospital environment and the need for reproducibility and evaluation of the clinical and economic results of this process (Fernandes et al., 2020).
In Brazil, studies on the implementation of medication reconciliation in health services need to be improved to enable the shaping of this relevant process, which favors the reality of Brazilian institutions in the prevention of medication-related errors and cost reduction from pharmaceutical services.
Aim
The present work aims to understand the avoided cost of medication discrepancies identified through the medication reconciliation service at the hospital level.
Ethics approval
This work was approved by the Ethics Committee and Research Involving Human Beings (CEP) of the Federal University of São João del-Rei (UFSJ), whose approval protocol is CAAE12092019.0.0000.5545, opinion number: 3.594.394.
METHODS
Setting and participants
This is a single-arm intervention study, linked to the assessment of cost savings, carried out in a hospital located in a municipality in the state of Minas Gerais, Brazil. All patients admitted to all ward units of Clínica Médica I between March and August 2020 were considered eligible for the study. Clínica Médica I has 38 active beds and receives on average, 92 hospitalizations per month.
Inclusion and exclusion criteria
All patients admitted to Clínica Médica I and registered in the institution's electronic system from the electronic medical record, who agreed to participate in the study, were included. Patients who evolved to death or stayed less than 24 hours were excluded. It is important to highlight that Clínica Médica I doesn’t have a specific group of patients admitted. However, children and patients who are only undergoing oncological treatment are not admitted at the service.
Intervention
At the time of hospital admission, the attending physician writes a medical prescription in an electronic medical record and the patient is referred to Clínica Médica I. Using the electronic system, the pharmacist can access the patient’s prescription and clinical progress history at the institution. Therefore, the clinical pharmacist checks the list of patients admitted to Clínica Médica I and selects patients who were admitted in the last 24 hours. This procedure is carried out daily by two clinical pharmacists who work on a 12x36 hour shift schedule. After the selection, clinical pharmacists recruited patients through a bedside visit with the patient and/or their caregiver. The length of hospital stay was calculated based on the classic indicator of hospital performance - Average Length of Hospital Stay (Brasil, 2012).
The development of the medication reconciliation service was carried out based on the 3C mnemonic, which consists of three steps in which each "C" represents a medication reconciliation step. 1) Collection: this is the first step and aims to obtain the best possible history of medication use by compiling a complete list of all medication that the patient uses. 2) Checking: in this step, the medication history obtained in the collection is compared with the prescriptions referring to the patient's position in the transition of care. 3) Communication: in this step, unintentional discrepancies are identified and communication is carried out with the professionals responsible for the treatment of the patient in the institution (Silvestre, Lyra Júnior, 2018).
In addition, a protocol proposed in The High 5s of the World Health Organization was used, which has five steps (WHO, 2017). The steps suggested by the protocol were developed in synchrony with the mnemonic steps. In step 1, (Collection) protocol steps 1 and 2 were developed; in step 2, (Checking) step 3 was developed; and in step 3 (Communication), steps 4 and 5 were developed (Figure 1 and 2).
Medication reconciliation steps according to The High 5s protocol of the World Health Organization and the 3C mnemonic.
In the first step, the pharmacist identified the patient and performed an anamnesis in order to collect information related to pharmacotherapy and fill out the electronic reconciliation system form, developed in accordance with the “Best Possible Medication History Interview Guide”, from the Canadian Institute for Safe Medicine Practice (ISMP, 2017). After data collection, the pharmacist confirmed the accuracy of the information to identify discrepancies and proceeded with the registration in the SPDATA system (electronic data management system used in the hospital) using the pharmaceutical evolution form in the electronic medical record. With the completed form, the pharmacist performed a search in the electronic system, in the prescription and medical evolution to verify which medications were listed and prescribed by the prescriber in the transition of care. The medication history collected by the pharmacist in the first step was then compared with the prescription and medical evolution.
Analysis of discrepancies
Any difference between the list of medications prepared by the pharmacist that the patient used at home (considered as a basis for comparison) and the hospital prescription was classified as a discrepancy, and then each discrepancy was classified as intentional or unintentional (Pippins et al., 2008).
Intentional discrepancies were considered as: when the prescriber reported the use of home medications in the medical evolution and chose not to prescribe them or to change the dose, frequency, or route of administration based on the clinical situation, or even when replacing a medication by another standardized therapeutic equivalent in the hospital.
Unintentional discrepancies were considered as: absence of reports of home medication use in the medical evolution, treatment started without clinical explanation; dose, frequency, or prescribed route of administration different from a medication already used by the patient, or in case of therapeutic duplicity, considering the patient home use.
When a discrepancy was found that was considered unintentional, the pharmacist performed a pharmaceutical intervention with the aim of resolving it.
Pharmaceutical interventions
Pharmaceutical interventions were numbered and categorized into: dose/posology adjustment, more appropriate/available therapeutic alternative, compatibility of medication via tube, therapeutic duplicity, inclusion of home medication, unnecessary medication, inappropriate medication, change of schedule, change of route of administration, and does not apply (when there was no need for intervention) (Ribeiro et al., 2015). Interventions were performed through information in the medical records, telephone, or personal contact with the prescriber. After carrying out and registering the intervention in the medical record, the pharmacist guided the patients at the bedside according to the assessment made of the situation of medication for home use. The orientations were categorized from 1 to 6 according to the outcome of the intervention carried out in the medication reconciliation:
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1) Use only medication dispensed by the hospital, awaiting analysis of the pharmaceutical intervention;
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2) Medication for home use will be dispensed by the hospital, do not use what is brought from the home;
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3) Medication for non-standardized home use in the hospital;
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4) Use only medication dispensed by the hospital;
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5) Correct way of storing medication for home use;
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6) Others (In case of need for other orientations not described, they were specified in the electronic medical record).
After completion of the pharmaceutical intervention, unintentional discrepancies were categorized in relation to the level of emergence of a probable harm in relation to the discrepancy, considered an error, if the intervention had not occurred. For this purpose, the medication error categorization index proposed by the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) and adapted by Gleason et al. (2004) was used, where the NCC MERP criteria were grouped into three categories: Level 1 (no potential harm), Level 2 (need for monitoring or potentially necessary intervention to avoid harm), and Level 3 (potential harm) (Gleason et al., 2004). Interventions classified as Level 1 received an estimate of zero cost for the resolution of possible harm, as they did not pose a risk of harm to the patient's health.
On a daily basis, the pharmacist performed an analysis of the medical record to verify the existence of any changes in the prescription and performed the categorization of the same in the instrument of medication reconciliation of the hospital “daily checklist”, as follows:
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Intervention accepted: When there was a change within 48 hours after the pharmaceutical intervention.
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Intervention not accepted: When there was no change in the prescription within 48 hours after the intervention was performed.
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Intervention partially accepted: When there was some modification related to the medication related to the intervention, but not in its entirety referring to what was suggested.
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Intervention not accepted with justification:
When there was no acceptance of the intervention with some justification by the prescriber or the patient was discharged before the 48-hour period.
Variables and data source
Data were collected from the daily checklist in Microsoft Excel® 2010 software and from the Electronic Patient Record (EPR). This contains the patient's registration information, in addition to the electronic prescription, medical evolution, and pharmaceutical evolution form. Data related to interventions and medication related to unintentional discrepancies were collected. In addition, the types of interventions carried out and the type of contact made to resolve them were collected.
Cost variables
The cost savings through the medication reconciliation service in the hospital environment were estimated from the perspective of the health service; the time horizon used was the monthly cost, considering the period of economic evaluation from July to August 2020. The estimate followed the following formulas:
Pharmaceutical intervention labor cost (CMOIF): pharmacist workload (CHF - monthly base salary plus labor charges/workload) x intervention (Lee et al., 2002). It is important to emphasize that the only cost analyzed related to the institution's investment in the medication reconciliation service, was the cost of the pharmacist's labor.
Cost of medication and materials (Lee et al., 2002)
The hospital's purchasing department works 8 hours a day, 5 days a week. Considering that the sector spends one working day (8 hours) a week to purchase medication and one day (8 hours) to purchase materials, the monthly cost of the sector was divided by 180 monthly hours and multiplied by 32 (thirtytwo) hours monthly that are required for the purchase. Subsequently, this amount was divided by the number of items (materials or medication) standardized in the institution, and the estimated amount spent on the purchase of each item was obtained. The value found was divided by the average monthly consumption of each item that is suggested in the SPDATA system.
Considering that the warehouse sector receives the items, checks them, enters the note into the data system and subsequently transfers these items to the central pharmacy, the monthly value of the sector was calculated, divided by the time spent to receive, check, and enter the item invoice, and transfer them to the pharmacy, dividing by the number of items (materials and medication) standardized in the hospital divided by the monthly average of the item in the institution.
The cost of dispensing materials and medication at the institution was calculated based on the monthly cost of the pharmacy for the institution, which is R$17,941.15 (US$3,437.00) divided by 2, as the pharmacy at the medical clinic also serves another sector of the hospital, the maternity sector, divided by 30 days, and later by 24 hours. The cost per hour of dispensing was divided by 60 minutes to find the pharmacy cost per minute to dispense medication and supplies.
CCOMAT: monthly cost of the sector/180 x 32/ number of standardized materials/monthly average consumption of material.
CALMAT: monthly cost of the sector/warehouse service time/number of materials/ monthly average.
CCOMED: monthly cost of the sector/purchase time/number of standardized medications/monthly average medication consumption.
CALMED: monthly cost of the sector/warehouse service time/number of medications/ monthly average.
Dispensing cost (CDISP): monthly cost of the sector/time spent to dispense each material/medication.
Total cost of material (CMAT): material value + CCOMAT + CALMAT + CDISP.
Total cost of a medication (CMED): gross medication value + CCOMED + CALMED + CDISP.
Nursing procedure cost (CPE): nursing technician monthly cost (base salary + labor charges/workload) x procedure time (Castilho, 2016).
Cost of medical services (CSM): medical professional monthly cost (on call value/daily minutes) x procedure time.
Cost of procedures and exams (CPROE): the cost table of the institution or exam was used (Abbas, Leoncine, 2014).
Cost of additional days of hospitalization (DMI): the average value proposed by the hospital cost sector was used (Abbas, Leoncine, 2014).
Total cost of a possible damage (CTPD): the sum of all estimated cost variables for the items that would be necessary to resolve some damage was performed.
The cost savings analysis on each medication involved in discrepancies was carried out and each observed discrepancy received an individual analysis according to the particularities of the medication involved, listing in each of them what would be the likely damage if there was no intervention. In this sense, we could realize the relationship between pharmaceutical orientations during the intervention and the cost savings, since the prevention of damage reduces unnecessary health expenses.
Additionally, the Internal Rate of Return (IRR) was calculated, which is the interest rate at which the Net Present Value (NPV) of an analyzed future cash flow equals the present value of the investment, that is, an average rate and a minimum at which the investment has a return, which occurs when the present value is equal to zero; the IRR assesses the feasibility of projects or monitors and compares the profitability of investments (Santos et al., 2017). For the conversion of values into dollars, the quotation of January 10th 2023 was used, where one dollar is equivalent to RS5.22.
RESULTS
A total of 150 patients were admitted to Clínica Médica I. However, there were 31 losses [refusals n= 6 (4.0 %); transferred from the ICU n= 3 (2.0 %); discharge in less than 24 hours n=20 (13.3 %); and death n=2 (1.3 %)], and 17 patients were not seen by the service due to the isolation of patients suspected of contamination by Covid-19. Thus, 102 pharmaceutical admissions were performed (68.0 %).
Regarding the profile of the 102 patients admitted by the medication reconciliation service, there is a predominance of females (52.9 %), mean age of 63.1 years (SD: 18.9), and with the most frequent age range of 70 years old or older (40.2 %) (Table I).
Characteristics of patients admitted by pharmacists in medication reconciliation, Pará de Minas - MG, 2020 (n=102)
The length of hospital stay ranged from 1 to 35 days of hospitalization, with an average length of hospital stay of 1.10 days.
With regard to medication reconciliation, in the 102 pharmaceutical admissions of patients participating in the study, 62 discrepancies were found, 37 (59.7 %) unintentional and 25 (40.3 %) intentional. Of the 102 patients admitted to the medication reconciliation service, 60 (58.8 %) did not receive any pharmaceutical intervention.
Forty pharmaceutical interventions were performed to resolve the 37 unintentional discrepancies. It is noteworthy that in two unintentional discrepancies, it was necessary to carry out more than one pharmaceutical intervention. There was a predominance in the category of pharmaceutical intervention related to the change and inclusion of home medication in the prescription, totaling 34 (87.1 %) interventions. The time to perform each intervention was on average 13 minutes (SD: 0.08), ranging from 5 to 41 minutes.
As for the acceptability of the interventions, it was found that 49.0 % were accepted or partially accepted by the prescribers, 20.0 % were not accepted and there was a justification by the prescriber, or the patient was discharged ahead of time to complete the intervention, and 31.0 % were considered not accepted after evaluating the medical prescription. There was a predominance of contact with the prescriber via medical records, 31 (77,5 %), followed by personal contact with the prescriber, 8 (20.5 %), and for contact via telephone, only 1 (2.5 %) (Table II).
Characteristics of pharmaceutical interventions carried out in the medication reconciliation service, Pará de Minas - MG, Brazil, 2020 (n=40)
The unintentional discrepancies involved 103 medications. The mean number of medications involved in a discrepancy per patient in which there was an unintentional discrepancy was 2.95 (±2.17). Of the total number of medications, there was a predominance of those that act on the cardiovascular system 33 (32.0 %), followed by those that act on the nervous system 26 (25.2 %), and digestive system and metabolism 18 (17.5 %).
During the medication reconciliation, 113 instructions were given to the patient. There was predominance in relation to the orientation to use only the hospital's medication, totaling 49 orientations (43.4 %) (Table III).
Instructions given to patients by pharmacists through the medication reconciliation service, Brazil (n=113)
With regard to the costs involved in reconciling medications, the pharmacist's labor cost totaled R$17.13 (US$3.28) per hour. Considering the time spent for each intervention, the value of the pharmacist's labor to carry out the interventions was R$8.50 (US$ 1.67).
Table IV represents the estimated cost savings for interventions performed in discrepancies classified as Level 2 and 3.
Estimated cost savings for interventions performed in discrepancies classified as Level 2 and 3
During the two months of the study, with the medication reconciliation service considering the interventions accepted, cost savings amounted to R$9,406.59 (US$1,802.03) for the hospital. In contrast, the cost of the pharmacist's labor to carry out all pharmaceutical interventions in the medication reconciliation service was R$8.50 (US$1.63). Additionally, the calculated IRR was 125,421.07 %.
DISCUSSION
This study analyzed the cost savings in reconciling medications and the interventions carried out by the service in the hospital environment. From the economic analysis it was possible to observe that the service represents cost savings for the hospital institution. In just two months of study, cost savings of the medication reconciliation service of R$9,406.59 (US$ 1,802.03) were identified for the hospital. Although there is a scarcity of studies that directly evaluate the cost avoided through medication reconciliation, this result corroborates the literature, which positively evaluates the insertion of the clinical pharmacist in the hospital environment, reporting the reduction in the risk of clinical complications, length of hospital stay, and costs with medications (Ghatnekar et al., 2013; Silva, 2017; Fontoura, 2019).
Extrapolating to an annual analysis, this service could have a cost saving of up to R$56,439.54 (US$ 10,812.17). In addition, the IRR found was 125,421.07 %. The analysis of this indicator makes it possible to consider the medication reconciliation service profitable in health, since few investments have a return over the first year, and the IRR found in this case is considered high. As a comparative example, government investments in sanitation works expect an IRR of 12 % to 16 % (Brasil, 2019) and the investment sector in planting native trees can expect an IRR of up to 28 % (Soares et al., 2021). Such comparisons demonstrate the high rate of return on investment found in this study, and consequently, the economic viability of carrying out the reconciliation service upon hospital admission.
It is known that pharmaceutical interventions generate great savings for hospital institutions (Aguiar et al., 2018; Arantes, Durval, Pinto, 2021). However, this study becomes a pioneer for filling a gap in the literature regarding the cost avoided by reconciling medications. The studies already developed, related to the costs of reconciling medications in a hospital environment, demonstrate cost-effectiveness analysis and cost minimization analysis (Herledan et al., 2020). The analysis of cost savings, through the analysis of the savings generated in the prevention of possible errors, proposes medication reconciliation as a tool capable of generating great economic benefits.
It is noticed that the values obtained, despite not realistically expressing savings generated for the hospital, represent a great potential for economic impact, mainly because the study was conducted in a medium-sized, philanthropic hospital with scarce financial resources. The scarcity of studies related to this theme makes it difficult to critically analyze and compare the results obtained. It is observed that the economy generated and the optimization of the resources found by this study demonstrate great possibilities of advances for the medication reconciliation service in the hospital environment. Considering that the monthly cost of a pharmacist for the institution is R$3,083.00 (US$ 590.61), the cost savings could result in the improvement of several demands of the institution, such as an increase in the number of pharmacists, better remuneration for pharmacists already allocated, and improvements in the physical infrastructure of the hospital pharmacy.
From a clinical point of view, the results found in this study confirm the importance of medication reconciliation in the prevention of medication errors and adverse events, since most discrepancies found (87.1 %) and consequently, interventions carried out, were related to the omission of medication. According to the literature, the most prevalent errors found in this study are avoidable and can cause harm to the patient, being one of the main causes of clinical complications and morbidities, which can lead to prolonged hospitalization and increased probability of adverse events related to the use of medication (Tyynismaa et al., 2017).
Since pharmaceutical intervention is an act that aims to solve or prevent problems that interfere or may interfere with the results of pharmacotherapy, the high number of interventions that occurred in the hospital environment demonstrate that this service can avoid errors and improve the quality of care and patient safety. Several studies (Schuch et al., 2013; Miranda et al., 2019; Guo et al., 2020) have shown similar values of unintentional discrepancies in medication reconciliation, with the omission of medication used by the patient also being the main error found and requiring their inclusion in the prescription. In the study by Ruiz (2016), the highest prevalence was the discrepancy of dose, by route or frequency, which were in second place in the present study (Ruiz et al., 2016).
A variable worth mentioning is the discrepancy related to therapeutic duplicity, which in this study presented a considerable frequency and differs from other published studies (Ribeiro et al., 2015; Fernandes et al., 2020). Therapeutic duplicity covers situations in which two or more medications are prescribed, containing the same medication or medications of the same pharmacological class in comparable doses and the same frequency of use, which may mainly increase the occurrence of adverse reactions (Cardinal, Fernandes, 2014). In this sense, the occurrence of therapeutic duplicity can predispose the patient to problems related to pharmacotherapy that could be avoided. It is clear, therefore, the importance of the pharmacist's role in reconciling medications in order to avoid these problems. Studies that evaluate medication reconciliation demonstrate a high number of interventions performed to avoid medication-related errors and reiterate the importance of intervention to prevent errors and increase the quality of hospital care (Cazarim, Araújo, 2015).
As for the acceptability of the pharmaceutical intervention, a higher percentage of acceptance was observed when compared to the percentage of nonacceptance by prescribers. However, the result is unsatisfactory considering that other studies report a percentage of acceptance of 71 % to 96 % of the interventions proposed by the pharmacist (Gleason et al., 2004; Castilho, 2016). The lower acceptance rate than reported in the literature can be explained by the fact that the study period coincided with the adaptation phase of the electronic medical record by the multidisciplinary team. This adaptation phase may have influenced the prescribers' assiduity in relation to accessing the patient's medical records, which may have caused them not to notice the interventions suggested by the pharmacist.
Analyzing the frequency of contact for carrying out the interventions, a greater number of contacts via medical records without verbal contact with the prescriber is observed. Therefore, there is a need for greater verbal contact with the prescriber, in order to enable better therapeutic conduct through interventions carried out by the clinical pharmacist. Verbal contact provides discussion between professionals leading to a common understanding, unlike the intervention described by the pharmacist in the data system in the patient's medical record (Cardinal, Fernandes, 2014). However, it presents itself as a challenge in hospitals with daily paid doctors who do not have established service schedule routines. Studies in which the type of contact made was only verbal obtained high prevalence of acceptance of pharmaceutical interventions (Cardinal, Fernandes, 2014; Lee, Fan, Kee, 2016).
When analyzing the average time used to reconcile medication on hospital admission, 13 minutes were found for each reconciliation. This result highlights the possibility of carrying out the service, since one of the difficulties encountered by professionals is the lack of time and work overload of the team (Coffey et al., 2009). For Santos et al. (2017) the time factor is a limiting factor for carrying out pharmacotherapeutic analyzes and interventions. However, the average time to carry out interventions in reconciling medication found in this study demonstrates the possibility of developing the service with the use of a reasonable period of time for each intervention.
The most prevalent medications found in pharmaceutical interventions, according to the ATC classification, coincide with what has already been reported in the literature. They are the most prevalent classes of use in the elderly, in addition to a large majority being chronic use (Silva, 2017). It is observed, therefore, that the results found are consistent with the morbidity profile in this population. It stands out as a differential in this study to others found in the literature, a considerable frequency of the class of systemic hormonal preparations. The total of 7.7 % of patients who had levothyroxine omitted in the hospital prescription stood out. Because it is a medication for continuous use, this finding strengthens the evidence of the risk of discontinuing the treatment of chronic diseases in the absence of medication reconciliation. Chronic diseases, such as hypothyroidism, require pharmacological treatment associated with non-pharmacological issues for their control. In this sense, the discontinuation of medication treatment can lead to lack of control of the disease and clinical complications, harming the health of patients.
The study analyzed the costs involved in reconciling medication and the interventions carried out by the service in the hospital environment in order to prevent possible harm to the patient. From the economic analysis, it was possible to observe that the service represents cost savings for the hospital institution, as the costs generated are outweighed by the benefits arising from the reconciliation service.
The results obtained make explicit the importance of the responsibility of the professional involved and the awareness of their role so that the medication reconciliation is considered effective. As in all activities carried out by this professional, in order for medication reconciliation to obtain satisfactory results and prevent the errors found, in addition to the commitment of the entire multidisciplinary team, it is essential that the pharmacist is committed and able to ensure safe, relevant, and convincing interventions (CFF, 2017). Regarding the limitations of the study, it is important to highlight, in addition to the pandemic scenario which represented a challenge in the world health scenario and a reality hitherto unknown and in need of special attention, the short period of intervention time, and the non-inclusion of all potential real costs that were generated, in addition to the non-inclusion of indirect costs that could be added to the cost of each possible error analyzed, if the pharmaceutical intervention did not occur. However, it is important to emphasize that this study is a pioneer for explaining, in the setting of a small Brazilian hospital, the clinical and economic feasibility of implementing medication reconciliation.
CONCLUSION
The economic approach of this study finds that medication reconciliation can considerably avoid costs in the hospital environment by preventing possible errors resulting from the omission of the history of medication used at home. In addition, the economic aspects of reconciliation related to the workforce of the pharmaceutical professional to perform the service represent a small financial portion compared to the health and economic benefits generated by this service. New pharmacoeconomic studies that economically assess the clinical outcomes of interventions carried out by the service would be necessary to complement and confirm the hypothesis presented in this work.
ACKNOWLEDGEMENTS
We would like to thank the Federal University of São João del-Rei (UFSJ).
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FUNDINGThis study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) -Finance Code 001. In addition, the study received support from the Research Support Foundation of the State of Minas Gerais - FAPEMIG and National Council for Scientific and Technological Development - CNPq.
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Edited by
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Associated Editor: Patricia Melo Aguiar
Publication Dates
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Publication in this collection
05 Dec 2025 -
Date of issue
2025
History
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Received
13 Mar 2024 -
Accepted
23 Oct 2024
