Discrepancies Identified Through a Telephone-Based, Student-Led Initiative for Medication Reconciliation in Ambulatory Psychiatry

Abstract

Purpose: To identify the number of medication discrepancies following establishment of a telephone-based, introductory pharmacy practice experience student-driven, medication reconciliation service for new patients in an ambulatory psychiatry clinic. Secondarily, to identify factors impacting medication discrepancies to better target medication profiles to reconcile and to evaluate whether the implementation of a call schedule effected clinic no-show rates. Methods: This was a retrospective analysis of a telephone-based medication reconciliation service from June 2014 to January 2016. Results: At least 1 medication discrepancy was identified among 84.7% of medication profiles (N = 438), with a total of 1416 medication discrepancies reconciled (3.2 discrepancies per patient). Of the 1416 discrepancies, 38.6% were deletions, 38.9% were additions, and 22.5% were changes in dosage strength or frequency. Discrepancies pertaining to prescription medications totaled 57.8%. Student pharmacists were critical team members in the service. Patient’s age, number of medications on the patient’s list, and number of days since the last medication reconciliation were not clinically significant determinants for targeting medication profiles. There was a statistically significant reduction in the clinic no-show rates following implementation of a call schedule compared with no-show rates prior to call schedule implementation. Conclusion: This student pharmacist–led telephone medication reconciliation service demonstrated the importance of medication reconciliation in ambulatory psychiatry by identifying numerous discrepancies within this population. Further, we demonstrated pharmacy students across various levels of education can assist in this process under the supervision of a pharmacist.