Medication discrepancies in older adults in Portugal’s primary health care

Abstract

ABSTRACT Introduction: Medication reconciliation is a clinical service that allows to compare the pharmacotherapeutic profile of the patient in different transition of care and has been reducing medication errors and preventing adverse drug events. Several studies have described this process in hospital setting, but medication reconciliation is not implemented broadly in primary health care. Thus, this study is aimed to describe the discrepancies found through medication reconciliation provided by clinical pharmacist in older adults in Portugal’s ambulatory setting. Methods: A descriptive cross-sectional study was carried out in the primary health care in Portugal. Elderly patients taking five or more medications were interview by clinical pharmacist regarding their current medication use in order to develop an updated list that was compared with the S. Miguel Health Center electronic medical record. Patients were eligible by family physician and forwarded to the clinical pharmacist’s consultation. Any discrepancies found were classified as omission, inclusion , dose , frequency , and duplication . Results: Twenty patients were analyzed with a mean age of 76.8 ± 6.01 years; half of them were women, taking a mean of 7.8 ± 2.23 drugs, and the most frequency comorbidities presented were hypertension (65.0%) and diabetes mellitus (50.0%). One hundred fifty-six different drugs were identified in prescriptions and most drugs involved were antihypertensives (23.2%). One hundred and thirty-eight discrepancies were identified with 39.0% classified such as omission, followed by frequency (32.0%), omission (21.0%), dose (7.0%), and duplication (1.0%). Conclusion: This study showed high medication discrepancies between updated medication list and electronic medical records in older adults, most of which classified such as inclusion. Our findings emphasize the role of clinical pharmacist to minimize medication errors in primary health care. Keyword: Medication Reconciliation, Patient Safety; Medication Errors, Community Pharmacy Services, Clinical Pharmacists