Effect of Medication Reconciliation on Unintentional Medication Discrepancies in Acute Hospital Admissions of Elderly Adults: A Multicenter Study

OBJECTIVES: To investigate the effect of pharmacy-based medication reconciliation on the frequency of unintentional medication discrepancies in acutely admitted individuals aged 65 and older. DESIGN: Multicenter intervention study with pre-post design. SETTING: Twelve Dutch hospitals. PARTICIPANTS: One thousand five hundred forty-three individuals aged 65 and older with an acute hospital admission through the emergency department. MEASUREMENTS: The intervention consisted of the Best Possible Medication History (BPMH), based on combining information from the community pharmacy record, the information provided by a structured interview with participants about their medication use, and medication containers. In nine hospitals, pharmacy technicians obtained the BPMH, and in three hospitals, a mixed model was used (physicians or pharmacy technicians obtained the BPMH). Primary outcome measure was the proportion of participants RESULTS: The proportion of participants with one or more unintentional medication discrepancies was reduced from 62% to 32% [odds ratio (OR) = 0.29, 95% confidence interval (CI) = 0.23-0.37]. These results remained statistically significant after adjustment for type of department and hospital (OR = 0.20, 95% CI = 0.15-0.26), and this effect remained stable for 6 months. Stratified analysis showed that no effect from the intervention was evident in the three hospitals with a mixed-model intervent CONCLUSION: Pharmacy-based medication reconciliation leads to a substantial reduction in medication discrepancies in acutely admitted elderly adults.