Research Notes
Medication reconciliation in a community pharmacy setting

https://doi.org/10.1331/JAPhA.2010.09121Get rights and content

Abstract

Objectives

To describe the types and frequencies of medication discrepancies identified through medication reconciliation in a community pharmacy setting, to identify potential correlations between a patient's electronic medical record (EMR) and pharmacy medication list, and to determine the relationship between patients who use prescribers and/or pharmacies outside of the Family Medicine Center (FMC) and the occurrence of medication discrepancies.

Methods

Cross-sectional comparison of patients' EMR medication lists and pharmacy medication fill history for a sample of patients presenting to the Family Medicine Pharmacy (FMP), which is located in the FMC on the University of Oklahoma Health Sciences Center campus in Oklahoma City. Discrepancies identified were classified according to one of six categories that included therapeutic duplication, medication exclusion, medications that should be designated inactive in the EMR medication list, and differences in medication strength, dosage form, or dosing regimen.

Results

A total of 100 patients were included. Most patients reported having all of their medications dispensed from FMP (89%), and most patients had prescriptions prescribed by FMC physicians only (57%). Each patient had an average of six medication discrepancies. Most discrepancies belonged to the inactive medication category (41%). The correlation between patients' FMP medication lists and their EMR medication lists was 0.73. Patients with one or more non-FMC prescribers had a greater number of medication discrepancies than patients with FMC prescribers only, but this relationship was not identified for those who used pharmacies outside of FMP (P = 0.0264 and 0.2580, respectively).

Conclusion

A variety of medication discrepancies were observed, signaling a need for medication reconciliation in the outpatient setting. Future research on this topic should focus on the implications of such discrepancies in the outpatient setting, interventions to reduce the number of discrepancies, and identifying patients at high risk for such discrepancies.

Section snippets

Objectives

The primary objectives of this study were to describe the types and frequencies of specific medication discrepancies identified through a process of medication reconciliation in a community pharmacy setting and to identify any correlation that exists between a patient's EMR and pharmacy medication list. An additional objective was to assess the relationship between patients who use prescribers and/or pharmacies outside of the Family Medicine Center (FMC) and the occurrence of medication

Methods

This study was conducted at the Family Medicine Pharmacy (FMP), which is located in the FMC on the University of Oklahoma Health Sciences Center (OUHSC) campus in Oklahoma City, and was approved by the OUHSC Institutional Review Board (IRB). Informed consent was deemed unnecessary by the IRB because no more than minimal risk was posed to each patient by a retrospective chart review and because access to patient records was restricted to those who had access during the course of usual patient

Results

A total of 107 potential participants were identified; however, 7 participants were not eligible to participate (5 not seeing FMC physician and 2 not taking five or more prescription medications). Therefore, a total of 100 participants were included. Table 1 shows the descriptive characteristics of the 100 participants included in the survey for analysis. Patients were primarily black (64%) and women (69%) and had an age range of 27 to 84 years. The majority of patients reported having all of

Discussion

The results of our study indicate that performing medication reconciliation in the community setting can identify a large number of potentially harmful discrepancies. Inactive medications listed as active and excluded medications were the most common discrepancies identified, which is consistent with other studies using a similar research approach.7,8 These discrepancies could lead to failure to prescribe an indicated drug or to therapeutic duplication with concentration-dependent adverse

Limitations

As a result of limited resources and time constraints, our data were collected from one community pharmacy practice site, which may limit the generalizability of our results to other practice settings. In addition, the community pharmacy from which data were collected is located in an academic family medicine practice group, whereas other community pharmacies desiring to implement similar research may not be located in such a site with unlimited access to patient EMRs.

Another limitation is that

Conclusion

This study confirmed that medication list discrepancies (and therefore inaccuracies) are common in the outpatient setting. These inaccuracies could result in patient harm, thereby reinforcing the need for reconciliation across all practice settings. Education of health care providers and patients about the implications of inaccuracies and strategies to minimize them is needed.

Our research has identified types and frequencies of medication list inaccuracies in one clinic-based pharmacy and

References (8)

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Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.

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