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Läkemedelsavstämningar hos äldre patienter vid inskrivning till slutenvård: farmaceutens roll i identifiering och åtgärd av diskrepanser
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
2015 (Swedish)Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
Abstract [en]

Background and objective

Medical discrepancies are common at admission to hospital. In 2012 provisions were updated in Sweden regarding medical reconciliations. Patients, 75 years and older, with five or more prescribed medications should be offered a medical reconciliation at admission to hospital. The primary objective of this study was therefore to evaluate the effect of the updated provision and the role of pharmacist in medical reconciliation. This was assessed by analysing the day of medical reconciliation in the care process. Secondary; type, degree of adjustment and potential risk factors indicating medical discrepancies were studied.


Design and Setting

The study was retrospective, evaluating medical reconciliations completed by pharmacists at internal medicine wards during a six-month period. The study was performed at Skåne University hospital, Sweden.


Main outcome measures

Medical discrepancies, type and the adjusted degree of them were categorised into the day of medical reconciliation after admission to hospital (Day 1-2, Day 3-4 and Day 5+). Age, number of prescribed medicines and presence of dispensing service were evaluated as potential risk factors.



589 patients were included in the study. 384 (65 %) had an adjusted medical discrepancy. Medians of 2 (IQR 1-4) adjusted medical discrepancies were found per patient. The day of medical reconciliation in the care process did not affect either the extent of patients with an adjusted medical discrepancy or the number of adjusted medical discrepancies per patient. Almost a third of the patients (31 %) had a medical reconciliation at day five or later after admission to hospital. The most common medical discrepancy was omission of a drug. No risk factors indicating medical discrepancies were identified.



A high number of patients received medical reconciliation late in the care process and not at admission to hospital. This despite updated provisions. The care team did not identify and adjust medical discrepancies when pharmacist service was not present. Structural medical reconciliations are a good method to reduce medical discrepancies and pharmacists are of value in that process. 

Place, publisher, year, edition, pages
2015. , 11 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-259068OAI: oai:DiVA.org:uu-259068DiVA: diva2:843088
External cooperation
Region Skåne
Available from: 2015-08-11 Created: 2015-07-26 Last updated: 2015-12-04Bibliographically approved

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