Pharmacist- versus physician-obtained medication histories

TLDR

The study compared medication histories obtained by physicians versus pharmacists in adult patients admitted to an internal medicine service at the University of Virginia Medical Center. Data were collected in two phases: a pilot with 20 patients using a pharmacist‑administered form without follow‑up, followed by a second phase with 55 patients where pharmacists intervened on identified discrepancies. Pharmacists documented 614 medications and 614 doses versus 556 medications and 446 doses by physicians, uncovered 353 discrepancies (including 58 previously unreported drugs), and corrected 142 of 161 pharmacist‑identified discrepancies after physician contact.

Abstract

Physician-obtained medication histories were compared to those obtained by a pharmacist.Patients whose medication histories were obtained were included in the evaluation if they were at least 18 years old and admitted to an internal medicine service at the University of Virginia Medical Center. Data were collected in two phases. The first 20 patients identified for inclusion were asked to provide an accurate medication history to pilot test the medication history form used by the pharmacist and received no pharmacist follow-up or interventions. In the second phase, patients were asked to provide an accurate medication history, and a pharmacist intervened when discrepancies in the pharmacist-obtained medication history were identified.A total of 55 patients were included in the study. The pharmacists identified 614 medications for these patients, compared with 556 identified by the physicians (p < or = 0.001). The pharmacist documented significantly more medication doses and dosage schedules than did physicians (614 versus 446 and 614 versus 404, respectively) (p < or = 0.001 for both comparisons). The pharmacist identified 353 discrepancies, including 58 medications not initially identified from the physician-obtained histories. The pharmacist intervened for 161 discrepancies, correcting 142 after contacting the respective physician; 19 medication discrepancies could not be justified by the physician.A total of 353 discrepancies were identified when medication histories obtained by physicians were compared with those obtained by a pharmacist during the study. During the intervention phase, the majority of discrepancies identified were either corrected by the pharmacist after contacting the respective physician or justified by the physician.