title: Patterns and predictors of medication discrepancies in primary care.
abstract: OBJECTIVE
  Identifying medication discrepancies across transitions of care is a common patient safety problem. Research examining relations between medication discrepancies and adherence, however, is limited. The objective of this investigation is to explore the relations between adherence and patient-provider medication discrepancies, and to test the hypothesis that non-adherence would be associated with medication discrepancies.
  
  
  METHODS
  Three hundred twenty-eight outpatients completed a current medication list and measures of health literacy, adherence, perceived physical functioning and subjective well-being. Patient lists were compared with active medications in the electronic medical record. Multivariate analyses identified demographic, clinical and patient-reported variables associated with discrepancies involving prescribed daily medications.
  
  
  RESULTS
  Despite high rates of self-reported adherence, patients reported taking fewer medications than the number of active medications in their medical record (3.79 vs. 4.83, P < 0.001). We identified one or more discrepancies in most records (294/328 or 89.6%). Identified discrepancies were completely reconciled in only 21.1% of patients with discrepancies. Discrepancies were associated with lower health literacy, poorer physical health status and subjective well-being, and poorer adherence to the regimen patients believed they had been prescribed. Multivariate analysis indicated that the number of medical record-reported medications and subjective well-being independently predicted the presence of discrepancies.
  
  
  CONCLUSIONS
  Findings suggest a complex relation between treatment adherence and medication discrepancies in which patient well-being and regimen complexity work in tandem to create discordance between patient and provider medication plans. Simplifying regimens when possible and attending to patient life satisfaction may improve adherence to a regimen constructed jointly between patient and provider.
authors.affiliation: Department of Psychiatry, The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY, USA.|Division of General Internal Medicine, North Shore University Hospital, North Shore-LIJ Health System, Manhasset, NY, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Coletti
authors.affiliation: Department of Medicine, North Shore-LIJ Health System, Manhasset, NY, USA.
authors.forename: Hara
authors.initials: H
authors.lastname: Stephanou
authors.affiliation: College of Pharmacy and Health Sciences, St. John's University, Queens, NY, USA.
authors.forename: Nissa
authors.initials: N
authors.lastname: Mazzola
authors.affiliation: Division of General Internal Medicine, Department of Medicine, North Shore-LIJ Health System, Manhasset, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Conigliaro
authors.affiliation: Department of Medicine, North Shore-LIJ Health System, Manhasset, NY, USA.
authors.forename: JoAnne
authors.initials: J
authors.lastname: Gottridge
authors.affiliation: Department of Psychiatry, The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D057220:Health Literacy; D006304:Health Status; D006801:Humans; D008297:Male; D059065:Medication Reconciliation / Q000706:statistics & numerical data*; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D057566:Self Report; D012959:Socioeconomic Factors; D016903:Drug Monitoring
keywords: electronic medical records; medication reconciliation; patient adherence; primary care; quality of care; quality of life