Medication reconciliation5/31/2023 ![]() ![]() There are also several methodological concerns about the study, the most serious of which is the possibility of selection bias, since only the patients in the intervention arm had to provide consent, and more than one-third did not and so were excluded only from that arm of the study (although if anything, this might bias the study in favor of the intervention). First, while the intervention was standardized and included the most important elements 2 (a “best possible medication history” by a pharmacy assistant, reconciliation by an experienced clinical pharmacist, communication with ordering physicians regarding possible medication changes), there are several questions about the fidelity of the intervention, including the extent to which the pharmacy assistants possessed verified competency in history-taking (which is by no means guaranteed), and the nature of the communication with physicians and the extent to which they followed the pharmacists’ advice. There are several possible reasons for this finding, related to both this study in particular and what we know about medication safety during care transitions. There were also no statistically significant differences in a range of secondary outcomes. 6 In this randomized clinical trial of 1702 patients who were aged 85 years or older and/or were receiving more than 10 medications at the time of hospital admission to 1 of 2 teaching hospitals in southern Switzerland, a standardized admission medication reconciliation intervention was associated with no difference in the incidence of 30-day readmissions or emergency department visits (39.3% vs 39.5%). This message is repeated in the study by Ceschi and colleagues. And yet, systematic reviews have failed to show this effect. 2 Given the high rate of drug-related problems after hospital discharge 3 and the fact that adverse drug events are by far the most common form of postdischarge adverse events, 4 it only stands to reason that effective medication reconciliation interventions should reduce hospital readmissions. 1 And multiple studies have also shown the ability of medication reconciliation to reduce these discrepancies. Multiple studies have shown the high prevalence of error in taking a preadmission medication history upon hospital admission and the high rate of unintentional medication discrepancies in admission and discharge orders. ![]() Medication reconciliation is an activity where the gap between face validity and proven benefit remains frustratingly large. ![]()
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