A student pharmacist-led medication reconciliation service and its impact on the identification of drug-related problems in an ambulatory clinic

Abstract

IntroductionDescribe a model of care in which student pharmacists are engaged in medication reconciliation services and document the impact of this model on the identification of drug therapy-related problems. Material and methodsStudent pharmacists in the PY4 year completing a required Advanced Ambulatory Care Pharmacy Practice Experience at a free clinic for indigent, uninsured adults conducted medication reconciliation services immediately prior to the patients׳ scheduled medical appointment with their physician. Following each encounter, students updated the medication list in the electronic medical record, clarified discrepancies, and identified the presence of drug therapy problems with the patient׳s physician. The main outcome measures included the presence of drug therapy-related problems, clinical interventions recommended to the provider, and recommendation acceptance rates. Recommendations were further categorized by disease state. ResultsStudents documented 673 clinical interventions. The most common type of problem identified was an untreated indication. Providers accepted 89% of the student pharmacists׳ recommendations. Interventions related to immunizations, hypertension, and diabetes were the most frequent. DiscussionStudent pharmacists can participate in medication reconciliation services in primary care settings at a level that contributes to the identification and resolution of drug-related problems. The utilization of students in this role is an effective strategy for the implementation of medication reconciliation services when resources are limited.