title: Pharmacist- versus physician-initiated admission medication reconciliation: impact on adverse drug events.
abstract: BACKGROUND
  Medication reconciliation (MR) has proven to be a problematic task for many hospitals to accomplish. It is important to know the clinical impact of physician- versus pharmacist-initiated MR in the resource-limited hospital environment.
  
  
  METHODS
  This quasi-experimental study took place from December 2005 to February 2006 at an urban US Veterans Affairs hospital. MR was implemented on 2 similar general medical units: one received physician-initiated MR and the other received pharmacist-initiated MR. Adverse drug events (ADEs) and a 72-hour medication-prescribing risk score were ascertained by research pharmacists for all admitted patients by structured record review. Multivariable models were tested for intervention effect, accounting for quasi-experimental design and clustered observations, and were adjusted for patient and encounter covariates.
  
  
  RESULTS
  Pharmacists completed the MR process in 102 admissions and physicians completed the process in 116 admissions. In completing the MR process, pharmacists documented statistically more admission medication changes than physicians (3.6 vs 0.8; P < 0.001). The adjusted odds of an ADE caused by an admission prescribing change with pharmacist-initiated MR compared with a physician-initiated MR were 1.04 with a 95% CI of 0.53 to 2.0. The adjusted odds of an ADE caused by an admission prescribing change that was a prescribing error with pharmacist-initiated MR compared with a physician-initiated MR were 0.38 with a confidence interval of 0.14 to 1.05. No difference was observed in 72-hour prescribing risk score (coefficient = 0.10; 95% CI, -0.54 to 0.75).
  
  
  CONCLUSIONS
  MR performed by pharmacists versus physicians was more comprehensive and was followed by lower odds of ADEs from admission prescribing errors but with similar odds of all types of ADEs. Further research is warranted to examine how MR tasks may be optimally divided among clinicians and the mechanisms by which MR affects the likelihood of subsequent ADEs.
authors: Department of Pharmacy, Veterans Affairs Western New York Healthcare System, Buffalo, USA. kari.mergenhagen@va.gov
authors: Kari A
authors: KA
authors: Mergenhagen
authors: Sharon S
authors: SS
authors: Blum
authors: Anne
authors: A
authors: Kugler
authors: Elayne E
authors: EE
authors: Livote
authors: Jonathan R
authors: JR
authors: Nebeker
authors: Michael C
authors: MC
authors: Ott
authors: Daniel
authors: D
authors: Signor
authors: Soojin
authors: S
authors: Sung
authors: Jessica
authors: J
authors: Yeh
authors: Kenneth S
authors: KS
authors: Boockvar
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D015331:Cohort Studies; D057286:Electronic Health Records; D006786:Hospitals, Urban; D006787:Hospitals, Veterans; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D008297:Male; D059065:Medication Reconciliation / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D010595:Pharmacists; D010820:Physicians; D055553:Prescription Drugs / Q000008:administration & dosage / Q000009:adverse effects*; D014481:United States
chemical_list: D055553:Prescription Drugs