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Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits.
Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences. Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. (eHälsoinstitutet)
Lunds universitet.
Lunds Universitet.
Lunds Universitet.
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2011 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 67, no 7, 741-752 p.Article in journal (Refereed) Published
Abstract [en]


To examine the impact of systematic medication reconciliations when admitted to hospital, and medication review while in hospital, on the number of inappropriate medications and unscheduled drug-related hospital revisits in elderly patients.


A prospective, controlled study in 210 patients, aged 65 years or older, who were admitted to one of three internal medicine wards at a University Hospital in Sweden. Patients received either standard care or care according to the Lund Integrated Medicines Management (LIMM) model. A multi-professional team, including a clinical pharmacist, provided medication reconciliations on admission and medication reviews during the hospital stay for the LIMM group. Blinded reviewers evaluated the appropriateness of the prescribing (using the Medication Appropriateness Index) on admission and discharge, and assessed the probability that a drug-related problem was the reason for any patient readmitted to hospital or visiting the emergency department within three months of discharge (using WHO causality criteria).


There was a greater decrease in the number of inappropriate drugs in the intervention group than in the control group for both the intention-to-treat population (51% [95% CI 43-58%] versus 39% [95% CI 30-48%], p=0.0446) and the per-protocol population (60% [95% CI 51-67%] versus 44% [95% CI 34-52 %], p=0.0106). There were 6 revisits to hospital in the intervention group which were judged as ‘possibly, probably or certainly drug-related’, compared with 12 in the control group (p=0.0469).


In this study, medication reconciliation and reviews provided by a clinical pharmacist in a multi-professional team significantly reduced the number of inappropriate drugs and unscheduled drug-related hospital revisits for elderly patients.

Place, publisher, year, edition, pages
2011. Vol. 67, no 7, 741-752 p.
Keyword [en]
Clinical pharmacy services, Medication Appropriateness Index, Medication review, Medication reconciliation, Drug-related problems, Inpatients
Keyword [sv]
Klinisk farmaci, Läkemedelsgenomgång, Läkemedelsavstämning, Läkemedelsrelaterade problem, Slutenvård, Olämpliga läkemedel, Återinläggning
National Category
Pharmaceutical Sciences
Research subject
Natural Science, Biomedical Sciences
URN: urn:nbn:se:lnu:diva-10170DOI: 10.1007/s00228-010-0982-3OAI: diva2:388928
Available from: 2011-08-22 Created: 2011-01-18 Last updated: 2012-04-12Bibliographically approved
In thesis
1. Clinical pharmacy services within a multiprofessional healthcare team
Open this publication in new window or tab >>Clinical pharmacy services within a multiprofessional healthcare team
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital.

Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate.

Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated.

Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced.

Place, publisher, year, edition, pages
Växjö, Kalmar: Linnaeus University Press, 2012. 63 p.
Linnaeus University Dissertations, 84/2012
Clinical pharmacy services, pharmacist, medication review, medication reconciliation, medication errors, drug-related problems, inappropriate prescribing, elderly, inpatients, patient readmissions, hospitalisation, multiprofessional, patient care team, continuity of patient care, Klinisk farmaci, farmaceut, läkemedelsgenomgång, läkemedelsavstämning, läkemedelsfel, läkemedelsrelaterade problem, olämpliga läkemedel, äldre, återinläggning, sjukhusinläggning, multiprofessionell, vårdteam, kontinuitet i vården
National Category
Social and Clinical Pharmacy
Research subject
Natural Science, Biomedical Sciences
urn:nbn:se:lnu:diva-18293 (URN)978-91-86983-47-5 (ISBN)
Public defence
2012-05-16, N2007, Västergård, Smålandsgatan 26E, Kalmar, 13:00 (Swedish)
Läkemedelsgenomgångar och läkemedelsavstämning - LIMM-modellen
Available from: 2012-04-12 Created: 2012-04-11 Last updated: 2012-10-08Bibliographically approved

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