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Medication discrepancies despite pharmacist led medication reconciliation: the challenges of maintaining an accurate medication list in primary care

机译：尽管药剂师主导了药物对账，但药物差异仍然存在：在初级保健中维持准确药物清单的挑战

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Objective : Describe the types of medication discrepancies that persist despite pharmacist-led medication reconciliation using the primary care electronic medical record (EMR). Methods : Observational case series study of established patients from an urban, indigent care clinic. Medication reconciliation was conducted immediately prior to the physician visit at baseline and return visit. Main outcome measures included: frequency, types, and reasons for discrepancies, patient knowledge, and adherence. Results : There was a 14.5% reduction in the number of patients with a discrepancy and the frequency of discrepancies was reduced by 7.3%. The rate of medication discrepancies in the chart was reduced by 31.3%. The most common type of discrepancy that persisted at follow up were medications listed on the chart that the patient stopped taking. Discrepancies were more likely to persist in Caucasian subjects when compared to African Americans. Conclusion : While pharmacist led medication reconciliation appears effective at reducing the likelihood of a medication discrepancy in the EMR, challenges persist in maintaining this accuracy specifically as it relates to patient driven changes to the medication regimen.
机译：目的：使用初级保健电子病历（EMR）描述尽管由药剂师主导进行药物对账仍存在的药物差异类型。方法：对城市贫困护理诊所的既定患者进行观察性病例系列研究。在医师回诊之前，立即在基线和回诊时进行药物调和。主要结局指标包括：出现差异的频率，类型和原因，患者知识和依从性。结果：出现差异的患者人数减少了14.5％，出现差异的频率减少了7.3％。图表中的药物差异率降低了31.3％。随访中最常见的差异类型是患者停止服用的图表上列出的药物。与非裔美国人相比，白人受试者中的差异更有可能持续存在。结论：虽然由药剂师领导的药物和解似乎可以有效降低EMR中药物差异的可能性，但要保持这种准确性特别是与患者驱动的药物治疗方案相关，仍然存在挑战。

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