title: Medication reconciliation at patient admission: a randomized controlled trial.
abstract: OBJECTIVE
  To measure length of hospital stay (LHS) in patients receiving medication reconciliation. Secondary characteristics included analysis of number of preadmission medications, medications prescribed at admission, number of discrepancies, and pharmacists interventions done and accepted by the attending physician.
  
  
  METHODS
  A 6 month, randomized, controlled trial conducted at a public teaching hospital in southern Brazil. Patients admitted to general wards were randomized to receive usual care or medication reconciliation, performed within the first 72 hours of hospital admission.
  
  
  RESULTS
  The randomization process assigned 68 patients to UC and 65 to MR. LHS was 10±15 days in usual care and 9±16 days in medication reconciliation (p=0.620). The total number of discrepancies was 327 in the medication reconciliation group, comprising 52.6% of unintentional discrepancies. Physicians accepted approximately 75.0% of the interventions.
  
  
  CONCLUSIONS
  These results highlight weakness at patient transition care levels in a public teaching hospital. LHS, the primary outcome, should be further investigated in larger studies. Medication reconciliation was well accepted by physicians and it is a useful tool to find and correct discrepancies, minimizing the risk of adverse drug events and improving patient safety.
authors.affiliation: Internal Medicine Department, Federal University of Paraná , Curitiba ( Brazil ). mmendesantonio@gmail.com.
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Mendes
authors.affiliation: Pharmacy Department, Federal University of Paraná , Curitiba ( Brazil ). natalia.f.lombardi@gmail.com.
authors.forename: Natália F
authors.initials: NF
authors.lastname: Lombardi
authors.affiliation: Hospital Pharmacy Unit of Clinics Hospital, Federal University of Paraná . Curitiba ( Brazil ). salvivania@gmail.com.
authors.forename: Vânia S
authors.initials: VS
authors.lastname: Andrzejevski
authors.affiliation: Internal Medicine Department, Federal University of Paraná . Curitiba ( Brazil ). gibran.af@gmail.com.
authors.forename: Gibran
authors.initials: G
authors.lastname: Frandoloso
authors.affiliation: Pharmacy Department, Federal University of Paraná . Curitiba ( Brazil ). cassyano.correr@gmail.com.
authors.forename: Cassyano J
authors.initials: CJ
authors.lastname: Correr
authors.affiliation: Internal Medicine Department, Federal University of Paraná . Curitiba ( Brazil ). m_carvalho@hotmail.com.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Carvalho
keywords: Brazil; Medication Reconciliation; Pharmaceutical Services; Randomized Controlled Trials as Topic