[Disagreement between physicians' medication records and information given by patients].
BACKGROUND
A survey was conducted to evaluate the level of disagreement between the drug records of family doctors and information provided by patients at the time of hospitalisation.


METHODS
One hundred patients acutely admitted to a hospital department of medicine were consecutively included if the patient ingested more than two non-OTC drugs. A second drug interview was performed shortly after admission, and the patient's current medication was recorded. If no written medical record from the referring family doctor was available at the time of admission, the doctor was contacted by phone for supplementary information. Discrepancies between the information given by the patient and the medical records of family doctors were recorded. The results were analysed blindly by two of the authors (one senior and one junior doctor) to determine if the discrepancies were clinically relevant for the patient.


RESULTS
We found at least one clinically relevant and potentially dangerous discrepancy in the medical records of 40% (95% CI 30%-50%) of the patients. In all, discrepancies were found in the drug lists of 63% of the patients. The patients with discrepancies were similar in age, sex, way of hospitalization and number of drugs ingested, compared to those without discrepancies. Afterwards the family doctors were invited to a meeting in which these problems were evaluated.


CONCLUSIONS
We conclude that there is an urgent need for improvement in the communication between the primary and secondary health care sectors concerning medication being prescribed for patients with chronic diseases. The large number of discrepancies in the drug records of patients in this study is discouraging.
Rabøl
Rasmus
R
Nykøbing Falster Centralsygehus, Medicinsk Afdeling, Faglig Udvikling i Almen Praksis (FUAP), Storstrøms Amt og Den Kgl. Veterinaer- og Landbohøjskole, Institut for Human Ernaering. rraboel@dadlnet.dk
Arrøe
Gry Rosenkjaer
GR
Folke
Fredrik
F
Madsen
Kristian Rørbaek
KR
Langergaard
Michael Thøger
MT
Larsen
Annette Højmann
AH
Budek
Tommy
T
Andersen
Jens Rikardt
JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003718:Denmark; D011307:Drug Prescriptions; D064420:Drug-Related Side Effects and Adverse Reactions; D005194:Family Practice; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008297:Male; D008498:Medical Record Linkage; D008499:Medical Records / Q000592:standards; D008875:Middle Aged; D010343:Patient Admission; D010349:Patient Compliance; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010821:Physicians, Family; D011446:Prospective Studies
D004364:Pharmaceutical Preparations