Research on elderly’s medication saves lives and resources

Incorrect use of medication is the cause of a third of all visits to accident and emergency departments among elderly people. For patients, this entails major health risks and for the health service, medicine-related injuries take up a lot of resources.

General practitioner Patrik Midlöv in the town of Eslöv was encountering elderly people on an almost daily basis who had been affected in one way or another by defective routines in the management of medication. These included incorrect medication, incorrect dosage, unsuitable combinations of medication or medication that had been prescribed without any obvious reason.

“Most people who work in primary care recognise the problem, but we have never had any figures on how big the problem is or any evidence-based methods to tackle it”, says Patrik Midlöv, who also conducts research and teaches on the medical degree programme at Lund University.

Serious flaws
With clinical pharmacist Tommy Eriksson at Skåne University Hospital in Lund, Patrik Midlöv carried out a study in municipal home nursing in the town of Landskrona.

“The study showed that 40 per cent of patients had one or more drugs that no one could explain the reasoning for. On average, two errors occurred every time a patient’s care setting changed.”

Several later studies have confirmed the results from Landskrona and this has led to the development of new methods to improve the use of medication among elderly people.

Medication reports
Clinical pharmacist Tommy Eriksson and consultant and geriatrician Lydia Holmdahl at Skåne University Hospital in Lund have developed a concept known as a medication report that follows patients through the chain of care in order to make it easier to see why different drugs have been prescribed.

“Explanations are given for all changes to medication during a stay in hospital, which means that a GP like myself can quickly gain an overview when the patient comes out of hospital”, says Patrik Midlöv. “This significantly reduces the risk of errors, while offering a natural starting point for a discussion on what medication the patient requires.”

New routines
Region Skåne is now introducing medication reports as a routine measure when patients are discharged from hospital, and several other county councils in Sweden are planning to follow suit.

“This is a major step forward. Now we need to raise awareness of the problem among hospital doctors and hospitals have to invest in pharmacists who can safeguard the quality of patients’ medication reports”, says Patrik Midlöv.

“At the same time, those of us working in primary care really need to make the effort and dare to take a holistic approach to patients’ use of medication based on sound knowledge that should preferably be acquired by medical students when they are still at university.”

“We must dare to take a holistic approach to patients’ use of  medication.”

The work to develop a model for medication reports has attracted a lot of attention and the team behind LIMM (Lund Integrated Medicines Management) has received the Golden Scalpel Award for innovation in the Swedish health service.
The jury described the model as “an outstanding example of development work that has proven benefits”.

“Ultimately, it is about taking a holistic and critical approach to the patient’s use of medication”, says Lydia Holmdahl. “A drug that was prescribed a year ago may long since have ceased to serve any purpose and it is therefore important to continually ask yourself if the drugs on the list are relevant.”

The information in the medication report is quality assured by a pharmacist and the prescribing doctor can thus get help to make a holistic assessment of the patient’s medication.

“It isn’t just about weeding the list of medication; it also means adapting the dose to the patient’s age or avoiding drugs that don’t work well together”, says Eva Rickhag, senior pharmacist at Skåne University Hospital in Lund.

GP Patrik Midlöv sees major advantages to having one foot in a clinical setting and the other in research and education.

“It means I can see where there is a need for further knowledge in the health service, at the same time as being able to implement the evidence-based knowledge from research into my clinical work. I find this inspiring and it means we can offer patients the best available care.”

Text: Sven-E Lindberg

Photo: Gugge Zelander

Published: 2013

Facts

Did you know...

… one third of all medical injuries in Sweden are due to incorrect medication management?

Elderly people with many different medicines are particularly vulnerable. It is calculated that 3 000 patients die every year in Sweden from medication-related problems. This is over ten times as many as die on the roads.