title: Effect of medication reconciliation on unintentional medication discrepancies in acute hospital admissions of elderly adults: a multicenter study.
abstract: OBJECTIVE
  To investigate the effect of pharmacy-based medication reconciliation on the frequency of unintentional medication discrepancies in acutely admitted individuals aged 65 and older.
  
  
  METHODS
  Multicenter intervention study with pre-post design.
  
  
  METHODS
  Twelve Dutch hospitals.
  
  
  METHODS
  One thousand five hundred forty-three individuals aged 65 and older with an acute hospital admission through the emergency department.
  
  
  METHODS
  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 with one or more unintentional medication discrepancies. The primary outcome measure was stratified according to type of intervention (pharmacy based vs mixed model).
  
  
  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 intervention, in contrast to the hospitals with a pharmacy-based intervention. The medication discrepancy types "omission" and "dosage or strength" occurred most frequently and were the main types that the intervention influenced.
  
  
  CONCLUSIONS
  Pharmacy-based medication reconciliation leads to a substantial reduction in medication discrepancies in acutely admitted elderly adults.
authors.affiliation: Department of Hospital Pharmacy, Erasmus Medical Centre, Rotterdam, the Netherlands. p.vandenbemt@erasmusmc.nl
authors.forename: Patricia M L A
authors.initials: PM
authors.lastname: van den Bemt
authors.forename: Erica M
authors.initials: EM
authors.lastname: van der Schrieck-de Loos
authors.forename: Christien
authors.initials: C
authors.lastname: van der Linden
authors.forename: Annemiek M L J
authors.initials: AM
authors.lastname: Theeuwes
authors.forename: Albert G
authors.initials: AG
authors.lastname: Pol
mesh_terms: D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D059065:Medication Reconciliation / Q000706:statistics & numerical data*; D009426:Netherlands; D010343:Patient Admission / Q000706:statistics & numerical data*; D004364:Pharmaceutical Preparations
chemical_list: D004364:Pharmaceutical Preparations
keywords: medication reconciliation; medication safety; pharmacy-based