Grant: Travel Awards - Institute Community Support

Background: Hospitalization is associated with numerous changes in the medications that patients are taking. Currently, efforts are being made to improve medication reconciliation practices at the time of hospital admission and discharge to decrease the probability of unintentional changes. Objective: To estimate medication discrepancies between hospital discharge prescriptions and filled medications 30-days after discharge, when an electronic medication reconciliation tool is used at the time of discharge. Methods: We conducted a study of patients seen at the McGill University Health Center in Montreal, Quebec, Canada from May to December 2014. Medication discrepancies were evaluated within 30-days of discharge and were defined as community medications that were discontinued at discharge and subsequently filled in the community, or medications that were prescribed at discharge and not filled in the community. Results: Among the 254 individuals included in our study, average age was 70, 41% were female, and 38% had three or more chronic conditions. Patients were prescribed a total of 3,096 medications at discharge (12 on average per person); 57% were continued community medications and 43% were added during the hospital stay. 1,223 (40%) were not filled in community, while of the 717 discontinued community medications, 12 (2%) were dispensed post-discharge. Conclusions: Medication discrepancies after discharge are common, thus, further research is required in this research area