Obtaining the correct drug history

The use of nationwide on-line prescription records improves the drug history in hospitalized patients

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Structured medication interviews improve the medication history upon hospitalization. Pharmacy records are valid lists of the prescribed medications available to individual patients. In Denmark, treating doctors now have access to their patients' pharmacy records through a real-time online electronic database What this study adds: Omission errors are frequent among hospitalized patients despite structured drug interviews and home visits. Pharmacy records may be used to minimize patients' recall bias and improve the medication lists.

BACKGROUND

Structured medication interviews improve the medication history in hospitalized patients. In Denmark, a nationwide electronic version of individual pharmacy records (PR) has recently been introduced. Use of these records could improve the medication lists in hospitalized patients.

METHODS

We prospectively included 500 patients admitted to an acute medical department. In individual patients, the PR was compared with (i) the medication list written in the patient chart and (ii) drug information provided by the patient during a structured drug interview upon admission and during a home visit after discharge.

RESULTS

Median patient age was 72 years. Upon admission, patients reported using 1958 prescription-only medications (POM) (median four drugs per patient, range 0-14), of which 114 (6%) were not registered in PR. In PR, 1153 POM (median one per patient, range 0-11) were registered during the month preceding admission. The patients did not report 309 (27%) of these upon admission. Home visits were performed in a subgroup of 115 patients. During home visits, 18% of POM registered in PR during the preceding month were not reported. Drug type was predictive of reporting irrespective of patient sex or age. Cardiovascular drugs were reported most and dermatological were reported less frequently. Underreporting might be due to recall bias, non-adherence or discontinuation of drugs.

CONCLUSIONS

Omission errors are frequent despite structured medication interviews. Pharmacy records or medication lists from all treating doctors must be included in medication reviews in order to reduce recall bias.

Medication history on internal medicine wards: assessment of extra information collected from second drug interviews and GP lists

PURPOSE

To assess the extra information about patients' pre-admission medication that second drug interviews and general practitioners' (GP) drug lists add to routine medication histories.

METHODS

The medication histories of 81 patients from two medicine wards were compared with information collected from second interviews and GP drug lists. A panel of clinicians assessed the potential clinical impact of any discrepancies.

RESULTS

In nine cases (11% CI: 6-20%) the medication history, the second interview and the GP lists were identical. The interviews revealed extra information about 54 prescription drugs and 72 over-the-counter drugs (OTCs) in 56 (69% CI: 58-78%) cases. The GP lists added 74 prescription drugs and 26 OTCs to the medication histories in 57 (70% CI: 60-79%) cases. Discrepancies were not associated with age, gender or number of drugs in medication history. In 18% (CI: 10-30%) of the cases, the specialist panel ascribed potential clinical problems to missing drug information.

CONCLUSIONS

Second interviews and GP lists reveal extra information about pre-admission medication in two-thirds of cases. Both procedures should be routinely performed to compile a more comprehensive basis for drug prescribing. This approach may mend the course of roughly one in five patients.