The effect of medication reconciliation on generating an accurate medication list in a pharmacogenomics practice

Abstract

Background: Medication reconciliation is recognized as a critically important medication safety element and a key initiative by multiple organizations. Within our precision medicine program, accurate medication lists are essential to our ability to make specific medication recommendations based on pharmacogenetic results. Our study aimed to identify discrepancies within the patient's medication list to improve medication management via genetic factors through a pharmacy team-based approach.Methods: A dedicated team of pharmacists and trained student pharmacists conducted telephone interviews to complete medication reconciliation for individuals enrolled in our precision medicine preemptive screening program. Medication list discrepancies were tracked as well as if pharmacogenetic consults were altered by findings during the telephone interviews.Results: Medication reconciliation was completed on 465 participants who had recently received or were awaiting pharmacogenetic testing. We found similar results to previously described rates of medication list discrepancies with an average of 4.9 medication discrepancies per patient as well as greater than 90% of individuals having at least one medication discrepancy. Pharmacogenetic recommendations for 20 individuals (4.3%) required adjustment following medication reconciliation.Conclusions: This pilot program supports the value of a dedicated team for medication reconciliation and the importance of accurate medication lists to optimize precision medicine programs.

Workforce Considerations When Building a Precision Medicine Program

“…Pharmacists review all PGx results and place chart notes in the EMR to alert providers when an actionable finding is identified [27]. Pharmacists may also connect with select patients to carry out medication reconciliation [31] and answer questions. Crucially, pharmacists, clinical informaticists, genetics providers, and specialty clinicians have worked to develop, test, evaluate, and refine point-of-ordering CDS that activates when PGx results indicate possible drug-gene interactions.…”