Discrepancies in post-discharge home treatment

Objective: To detect and describe discrepancies in post-discharge home treatment in polymedicated patients over 64 years of age, to inform the primary care physician (PCP) of these discrepancies, and to assess the PCP's satisfaction with the information provided. Method: A prospective observational study was carried out by a multidisciplinary team between March and December 2011. The sample group was made up of patients admitted to the Internal Medicine Unit of Hospital La Linea, run by the Andalusian Public Health Service in Cadiz, Spain. Three weeks after the patients were discharged, a medication reconciliation process was carried out in their homes. This process observed the changes made to their prescriptions during their hospital stay and their electronic medical record. Discrepancies were detected and categorised according to type (omission; prescribing error; error in dosage, administration method and/or frequency, replacement; and duplication). A report was then sent to the patient's PCP, telling him or her about the discrepancies found. Results: 112 patients were included in the study. The average age of patients in the study group was 76.8 ±6.6 years and 53.6% (60) were men. At least one discrepancy between the patient's long-term treatment and the hospital treatment prescribed was detected in 95.5% of patients in the study group (95% CI: 89.9-98.1%). 514 discrepancies were detected in total, with an average of 4.8 ±3 discrepancies per patient. Errors in dosage or administration method and/or frequency were found in 70.5% of patients (95% CI: 61.5-78.2%), while prescribing errors were detected in 58% (95% CI: 48.8-66.8%), and omission errors in 51.8% (95% CI: 42.6-60.8%). The relevant PCP was informed of the discrepancies (or lack thereof) in 100% of cases. 42% (47) of PCP completed and returned the satisfaction survey enclosed with the discrepancy report. 85.1% (40) of the PCP who completed the survey said that the information was clear, and 87.2% (41) said it was useful. Conclusion: The prevalence of discrepancies in long-term treatment in polymedicated patients over 64 is very high. The most frequent discrepancies are errors in dosage, administration method and/or frequency. The PCP were very satisfied with the information provided about the discrepancies detected in their patients