Medication discrepancies despite pharmacist led medication reconciliation: the challenges of maintaining an accurate medication list in primary care

Objective: Describe the types of medication discrepancies that persist despite pharmacist-led medication reconciliation using the primary care electronic medical record (EMR). Methods: Observational case series study of established patients from an urban, indigent care clinic. Medication reconcilia...

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Main Authors: Stewart AL, Lynch KJ
Format: Article
Language:English
Published: Centro de Investigaciones y Publicaciones Farmaceuticas 2014-03-01
Series:Pharmacy Practice
Subjects:
Online Access:http://www.pharmacypractice.org/journal/index.php/pp/article/view/360
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author Stewart AL
Lynch KJ
author_facet Stewart AL
Lynch KJ
author_sort Stewart AL
collection DOAJ
description Objective: Describe the types of medication discrepancies that persist despite pharmacist-led medication reconciliation using the primary care electronic medical record (EMR). Methods: Observational case series study of established patients from an urban, indigent care clinic. Medication reconciliation was conducted immediately prior to the physician visit at baseline and return visit. Main outcome measures included: frequency, types, and reasons for discrepancies, patient knowledge, and adherence. Results: There was a 14.5% reduction in the number of patients with a discrepancy and the frequency of discrepancies was reduced by 7.3%. The rate of medication discrepancies in the chart was reduced by 31.3%. The most common type of discrepancy that persisted at follow up were medications listed on the chart that the patient stopped taking. Discrepancies were more likely to persist in Caucasian subjects when compared to African Americans. Conclusion: While pharmacist led medication reconciliation appears effective at reducing the likelihood of a medication discrepancy in the EMR, challenges persist in maintaining this accuracy specifically as it relates to patient driven changes to the medication regimen.
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spelling doaj.art-ed9269ca17304548aadd038c76d4d4d52022-12-21T23:47:37ZengCentro de Investigaciones y Publicaciones FarmaceuticasPharmacy Practice1885-642X1886-36552014-03-01121360Medication discrepancies despite pharmacist led medication reconciliation: the challenges of maintaining an accurate medication list in primary careStewart AL0Lynch KJDivision of Clinical, Social and Administrative Sciences. Mylan School of Pharmacy, Duquesne University. Pittsburgh, PA (United States). Objective: Describe the types of medication discrepancies that persist despite pharmacist-led medication reconciliation using the primary care electronic medical record (EMR). Methods: Observational case series study of established patients from an urban, indigent care clinic. Medication reconciliation was conducted immediately prior to the physician visit at baseline and return visit. Main outcome measures included: frequency, types, and reasons for discrepancies, patient knowledge, and adherence. Results: There was a 14.5% reduction in the number of patients with a discrepancy and the frequency of discrepancies was reduced by 7.3%. The rate of medication discrepancies in the chart was reduced by 31.3%. The most common type of discrepancy that persisted at follow up were medications listed on the chart that the patient stopped taking. Discrepancies were more likely to persist in Caucasian subjects when compared to African Americans. Conclusion: While pharmacist led medication reconciliation appears effective at reducing the likelihood of a medication discrepancy in the EMR, challenges persist in maintaining this accuracy specifically as it relates to patient driven changes to the medication regimen.http://www.pharmacypractice.org/journal/index.php/pp/article/view/360Medication Reconciliation; Electronic Health Records; Medication Errors; Continuity of Patient Care; United States
spellingShingle Stewart AL
Lynch KJ
Medication discrepancies despite pharmacist led medication reconciliation: the challenges of maintaining an accurate medication list in primary care
Pharmacy Practice
Medication Reconciliation; Electronic Health Records; Medication Errors; Continuity of Patient Care; United States
title Medication discrepancies despite pharmacist led medication reconciliation: the challenges of maintaining an accurate medication list in primary care
title_full Medication discrepancies despite pharmacist led medication reconciliation: the challenges of maintaining an accurate medication list in primary care
title_fullStr Medication discrepancies despite pharmacist led medication reconciliation: the challenges of maintaining an accurate medication list in primary care
title_full_unstemmed Medication discrepancies despite pharmacist led medication reconciliation: the challenges of maintaining an accurate medication list in primary care
title_short Medication discrepancies despite pharmacist led medication reconciliation: the challenges of maintaining an accurate medication list in primary care
title_sort medication discrepancies despite pharmacist led medication reconciliation the challenges of maintaining an accurate medication list in primary care
topic Medication Reconciliation; Electronic Health Records; Medication Errors; Continuity of Patient Care; United States
url http://www.pharmacypractice.org/journal/index.php/pp/article/view/360
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