IOSR Journal of Pharmacy and Biological Sciences (IOSR-JPBS) e-ISSN: 2278-3008, p-ISSN:2319-7676. Volume 10, Issue 6 Ver. I (Nov - Dec. 2015), PP 43-50 www.iosrjournals.org DOI: 10.9790/3008-10614350 www.iosrjournals.org 43 | Page Study of medication appropriateness during hospital stay and revisits in medicine department of tertiary care hospital Vineeta Dhyani 1 , Pankaj Mohan Dhyani 2 , Geetanjali Salimath 1 , Charu Pundir 3 1 (Department of Pharmacy Practice, K.L.E College of Pharmacy, K.L.E University, India) 2 (Department of Pharmacology, S.G.R.R.I.T., Uttarakhand Technical University, India) 3 (Department of Pharmacology, K.L.E College of Pharmacy, K.L.E University, India) Abstract: The primary objective was to identify the medication reconciliations among elderly, based on Lund integrated medicines management (LIMM), during their admission and discharge from hospitals. The secondary objective was to study the impact of LIMM based patients within 6 months of their hospital discharge and revisits. It was a prospective surveillance study in which 120 patients aged ≥65 years or old intervention patients, received LIMM model. The control patients received standard care medication reconciliation at discharge by the help of medication appropriateness index (MAI). This study evaluated the appropriateness on admission and discharge, and assessed, whether the drug related problem was the reason of readmission or visiting to hospital within 6 months of discharge. It was observed that there was a significant decrease in the number of inappropriateness drugs in the intervention group as compared to control group. Hence, there was a significant inappropriateness observed in elderly patients which indicates the medication reconciliation and review according to LIMM and reduce the number of inappropriate drug and number of revisits. Keywords - Medication appropriateness index; Medication inappropriateness in elderly; Drug-drug interaction; Medication review; LIMM model. I. Introduction Drug treatment is a key necessity of medical care for the elderly patients and has the potential to reduce morbidity and mortality in order to ensure good health. However, problems related to drug treatment are common among elderly hospitalized patients, who further interfere with desired health outcomes [1-2]. Drug- related problems (DRP) are the world’s fourth leading causes of death [3-5]. Possible underlying causes of drug- related hospital admissions have been identified; as an instance due to medication errors, suboptimal prescription, poor patient compliance, polypharmacy, insufficient monitoring and follow-up and lack of information among patients [6-7]. Thus, it becomes very important to study, identify the root cause and correct the medication errors. As an integrated medicines management approach, various methods have been widely used in several countries in order to find the reason for medication inappropriateness to improve the health care deliver [8-9]. It is the need of an hour to implement rationale use of standard and accurate medication systems at the time of admission, to prevent medication errors and other drug reactions during the hospital stay and at discharge [10-11]. Incorporating pharmacist recommendations, use of computerized alerts, review of patient’s medication list and patient education systems can be used to study medication inappropriateness, which is supported by controlled trials, thus providing a higher level of evidence to support [12]. Review of patient’s medication list is the widely used tool to assess medication inappropriateness (MI) using MAI scoring method [13]. Medication appropriateness was effectively used by Lund integrated medicines management (LIMM) model [14]. LIMM model offers a systemic approach for individualizing and optimizing drug treatment in elderly patients [14-19]. Since for past 10 years, this model has been widely used in many Swedish hospitals to assess MI. The key principle underlying this model is to access a clinical intervention that can reduce the chances of medication errors. These interventions are supposed to be given at the time of hospital admission, team interventions for medication reviews and monitoring during the hospital stay [20] [21-23] [24-27]. The model covers various aspects of the use of medications from appropriate prescriptions to the way in which drugs have to be taken or not taken by the patients. It is a validated instrument to study medication inappropriateness by ensuring that the medication regimen is appropriate, safe, cost effective and correct use [25]. Earlier studies showed positive effects on the appropriateness of drug therapy using LIMM model, and this model is widely used by many medical scientists. However, this model is associated with certain limitations when used in India, due to improper maintenance of patient’s records, insufficient administrative services, a bsence of clinical pharmacist in hospitals and standard medication lists. The present work was carried out mainly to study and identify the medication reconciliations among elderly, based on LIMM, during their admission and discharge from hospitals. The secondary objective was to examine the impact of LIMM based patients within 6 months of their hospital discharge and revisits.