Medication Discrepancies in Community Pharmacies in Switzerland: Identification, Classification, and Their Potential Clinical and Economic Impact

Abstract

Background: Transitions of care are high-risk situations for the manifestation of medication discrepancies and, therefore, present threats for potential patient harm. Medication discrepancies can occur at any transition within the healthcare system. Methods: Fifth-year pharmacy students assessed a best possible medication list (BPML) during a medication review (based on medication history and patient interview) in community pharmacies. They documented all discrepancies between the BPML and the latest medication prescription. Discrepancies were classified using the medication discrepancy taxonomy (MedTax) classification system and were assessed for their potential clinical and economic impact. Results: Overall, 116 patients with a mean age and medication prescription of 74 (± 10.3) years and 10.2 (± 4.2), respectively, were analyzed. Of the 317 discrepancies identified, the most frequent type was related to strength and/or frequency and/or number of units of dosage form and/or the total daily dose. Although, the majority of discrepancies were rated as inconsequential (55.2%) on health conditions, the remainder posed a potential moderate (43.2%) or severe impact (1.6%). In 49.5% of the discrepancies, the current patients’ medication cost less than the prescribed. Conclusion: Community pharmacies are at a favorable place to identify discrepancies and to counsel patients. To improve patient care, they should systematically perform medication reconciliation whenever prescriptions are renewed or added.

Economic Evidence for Pharmacist-Led Medicines Use Review and Medicines Reconciliation

“…2001): concealment of allocation, use of intention-to-treat analysis and data checking; 4 criteria recommended by the York Centre for Reviews dissemination: explicit statement of inclusion criteria; baseline comparability between groups; a clearly defined primary outcome; and sample size calculation reported /NHS) and 2 criteria defined by the review team: length of follow-up (6 months was considered adequate), >80% of patients retained in the trial, and reporting the training or selection of pharmacists. 2 "Primarily MedRec studies" = MedRec is the primary element of the intervention or "Supplemented MedRec studies" = MedRec is supplemented often with pharmacotherapy consultation or medication review, patient consultation and discharge planning 3 not specified for one study 4 The process of identifying the most accurate list of a patient's current medicines including the name, dosage, frequency and route-and comparing them to the current list in use, recognizing and documenting any discrepancies, thus resulting in a complete list of medications' 5 random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, other bias, sample size calculation The studies that assess the economic impact and cost-effectiveness of MUR generally focus on patients ≥ 65 years: mean age of participants in the 32 included studies of Holland et al ( 2008) [19] ranged from 61 and 85 years; with an only one study limited inclusion to specific diagnoses (either chronic obstructive pulmonary disease (COPD) or hypertension). In an implementation study of MUR in Spain, the target subjects were adults patients belonged to one of the following groups: (1) users of complex medicines, (2) users of high-risk medicines;…”

“…Because evidence of the impact of MUR and MedRec focuses on safety outcomes (DRP and medication discrepancies respectively), it may also be appropriate to better assess direct clinical and economic impacts, rather than using indicators of healthcare use. For example, a Swiss study identified, characterized and categorized medication discrepancies occurring in adult community pharmacy customers with long-term polypharmacy use for any transition in the healthcare system using two classification systems [4]. Potential direct or indirect clinical impact of each medication discrepancy on the patient's medical conditions was evaluated using three different severity classes: "unlikely", "moderate" or "potentially severe" adapted from Cornish et al (2005) [35].…”

“…MUR and MedRec are a combination of "diagnostic" and "resolution" interventions meaning that not every patient who receives them will have a DRP or patient-related medication discrepancy; and those identified can be clinically and/or economically inconsequential [4]. In economic terms, it is therefore expected that the additional cost of delivering one of these interventions (section 2) will either be covered by the costs avoided as a result of the detection and resolution of patient-related DRPs or medication discrepancies, or lost if there are no avoided costs.…”

Interdisciplinary Physician-Pharmacist Medication Review for Outpatients With Heart Failure: A Subanalysis of the PHARM-CHF Randomized Controlled Trial

“…This is a major challenge as the medications stated by the patient, but not documented by the physician, were often associated with a high risk for falls, hospitalization, or drug-drug interactions (Rose et al, 2018). In particular, drugs acting on the cardiovascular system are prone for deviations; therefore, CHF patients are commonly affected by drug discrepancies (Ekedahl et al, 2011;Rose et al, 2018;Giannini et al, 2019;Imfeld-Isenegger et al, 2020). Additionally, the frequency of discrepancies increased with patient age, the involvement of a specialist, and the patient's unfamiliarity with the medication (Bedell et al, 2000).…”

“…Different types of medication discrepancies have been classified: drug omission and drug addition, as well as deviations in strength, frequency, number of units, or daily dosage ( Almanasreh et al, 2019 ). The potential to harm the patient is clinically relevant ( Imfeld-Isenegger et al, 2020 ).…”