• FTGM
• medication reconciliation
• drug-drug interactions
• interazioni farmacologiche
• hospital pharmacist
• farmacista ospedaliero
• polypharmacy
• polifarmacia

A drug interaction occurs when the pharmacokinetic behavior and / or therapeutic effects of a drug are altered by the concomitant administration of a second drug in the same therapeutic regimen. We can divide the interactions by the underlying mechanism of action into pharmacodynamic and pharmacokinetic ones, the latter in turn divided into interactions in absorption, distribution, metabolism and elimination.
Regardless of the mechanism, an interaction-induced adverse drug event(ADE) can expose the patient's health at risk and at the same time can increase the costs for the national health system.
Since many drug interactions are known and easily preventable, their study could help reducing adverse drug events that are currently responsible for 6.5% of hospital admissions [Pirmohamed et al., 2004]. One possible tool to reduce the number of potential drug interactions in a complex care setting, such as hospital therapy, is the Medication Reconciliation (MedRec). Since the early 2000s, this clinical practice has been the standard of care in most hospitals in northern Europe and specifically in the United Kingdom. The world health organization (WHO), through the drafting of a specific guide, documents its effectiveness and suggests its implementation in all hospital centers. In 2014, the Ministry of Health published Ministerial Recommendation n.17 where the indications promoted by the WHO are acknowledged and suggested the implementation of MedRec also in Italian hospitals.
Fondazione Toscana Gabriele Monasterio (FTGM) had implemented the Ministerial Recommendation through the company procedure n.61, in order to guarantee the correct management of the patient's drug therapy and to share the operating procedures with the stakeholders involved.
In a previous study carried out by FTGM, drug therapies at discharge were analyzed. In this thesis work we aimed to continue the analysis of patients in whom at least one potential drug interaction has been highlighted in the therapy at discharge. In this perspective, the home therapy of the 3 months before admission was examined in order to dimension the phenomenon of drug interactions in this context and to understand the origin of the interactions recorded at discharge.