The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Letter to the Editor
Editor, – I read the timely article by Ms Duguid on medication reconciliation (Aust Prescr 2012;35:15-9) with great interest. Prescribing is a common but often complex and challenging intervention. With a meteoric rise in the ageing population, its attendant polypharmacy and the shift of chronic disease management to primary care, the majority of prescribing will happen in primary care. The peri-discharge period can be perilous. However the article fails to mention some proven strategies in reconciliation such as:
- referring patients for a home medicines review within a stipulated period of discharge (ideally within two days) thereby avoiding rebound admissions and medication misadventures
- engaging a hospital or consultant pharmacist to liaise with the patient’s general practitioner, given that managing patients on multiple drugs can be time consuming and require delicate balancing of guidelines and clinical complexities
- checking for potentially inappropriate medicines using Beers Criteria. An Australian version of this list is currently being considered.1
With the proliferation of prescribing rights, relevant curricula (medicine, pharmacy and nursing) need to be restructured to explicitly include therapeutics as a formal part of the training. This will build the knowledge and skill base for the quality use of medicines, ideally in an interdisciplinary milieu.
I wish to thank Ms Duguid for highlighting the magnitude of medication-related problems both in individual patients and as a public health issue. I hope there is a strong political commitment to the quality use of medicines which is a central tenet of Australia’s National Medicines Policy.
- Bell SJ, Le Couteur D, McLachlan AJ, Chen TF, Moles RJ, Basger BJ, et al. Improving medicine selection for older people – do we need an Australian classification for inappropriate medicines use? Aust Fam Physician 2012;41:9-10.
- Nguyen A, Yu K, Shakib S, Doecke CJ, Boyce M, March G, et al. Classification of findings of home medicines reviews in post-discharge patients at high risk of medication misadventure. J Pharm Pract Res 2007;37:111-4.
- Angley MA, Ponniah AP, Spurling LK, Sheridan L, Colley D, Nooney VB, et al. Feasibility and timeliness of alternatives to post-discharge home medicines reviews for high-risk patients. J Pharm Pract Res 2011;41:27-32.
- Elliot RA, Tran T, Taylor SE, Harvey PA, Belfrage MK, Jennings RJ, et al. Gaps in continuity of medication management during transition from hospital to residential care: an observational study (MedGap Study). Australas J Ageing 2012. DOI: 10.1111/j.1741-6612.2011.00586.x