Evaluation of Adverse Drug Events and Medication Discrepancies in Transitions of Care Between Hospital Discharge and Primary Care Follow-Up

J Pharm Pract. 2016 Apr;29(2):132-7. doi: 10.1177/0897190014549836. Epub 2014 Oct 13.


Approximately two-thirds of adverse events posthospital discharge are due to medication-related problems. Medication reconciliation is a strategy to reduce medication errors and improve patient safety.

Objective: To evaluate adverse drug events (ADEs), potential ADEs (pADEs), and medication discrepancies occurring between hospital discharge and primary care follow-up in an academic family medicine clinic. Adult patients recently discharged from the hospital were seen by a pharmacist for medication reconciliation between September 1, 2011, and November 30, 2012. The pharmacist identified medication discrepancies and pADEs or ADEs from a best possible medication history obtained from the electronic medical record (EMR) and hospital medication list. In 43 study participants, an average of 2.9 ADEs or pADEs was identified (N = 124). The most common ADEs/pADEs identified were nonadherence/underuse (18%), untreated medical problems (15%), and lack of therapeutic monitoring (13%). An average of 3.9 medication discrepancies per participant was identified (N = 171), with 81% of participants experiencing at least 1 discrepancy. The absence of a complete and accurate medication list at hospital discharge is a barrier to comprehensive medication management. Strategies to improve medication management during care transitions are needed in primary care.

Keywords: medication reconciliation; pharmacist; primary care; transitions of care.

MeSH terms

  • Continuity of Patient Care*
  • Drug-Related Side Effects and Adverse Reactions / prevention & control*
  • Electronic Health Records
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Medication Errors / statistics & numerical data*
  • Medication Reconciliation / statistics & numerical data*
  • Middle Aged
  • Patient Discharge
  • Pharmacists
  • Primary Health Care
  • Professional Role