During the study, 91 medical charts were reviewed. Thirty-nine (43%) patients were deemed ineligible on the basis of predefined inclusion and exclusion criteria. The other 52 patients were approached by the primary investigator (J.T.), and 50 (96%) of these provided written informed consent to participate in the study.

The mean age of the study population was 64.6 years (standard deviation [SD] 18.1, range 20-95), and 27 (54%) were female. Seventeen (34%) of the 50 patients reported an allergy to at least one medication. The most common reasons for admission were gastrointestinal (11 patients [22%]), infectious disease (9 patients [18%]), cardiovascular (7 [14%]), and respiratory (7 [14%]). Seventeen patients (34%) had been admitted to hospital in the preceding year.

Table 1. Comparison of Number of Medications Obtained by Different Methods for 50 Patients


Total No. of Medications (Mean/Patient)


Category of
Medication


By Interview PIP
Data


Mean Difference per
Patient


All


378 (7.6) 235 (4.7)


2.9*


Prescription only


282 (5.6) 225 (4.5)


1.1*

PIP = Pharmaceutical Information Program, SD = standard deviation. *p < 0.001.

The primary investigator (J.T.) completed a BPMH with each of the 50 patients. The mean interview time was 12.4 min (SD 6.0, range 3-35). In addition, 4.8 min (SD 1.4, range 2-10) was spent reviewing the patient’s medical chart, 1.1 min (SD 0.3, range 1-2) accessing the patient’s PIP profile, and 4.2 min (SD 2.2, range 0-11) reviewing the patient’s PIP profile before obtaining the BPMH. The mean total time spent per patient was 22.5 min (range 10-54). Nine patients (18%) had medication vials, a medication list, and/or a compliance pack available for inspection. Medications were clarified with the community pharmacy (34 patients [68%]), family physician (4 [8%]), and/or caregiver (7 [14%]) when necessary.The PIP is not designed to capture nonprescription or herbal medications that a patient may be taking. As a result, the remainder of the results section focuses on discrepancies related to prescription medications only. During the interviews, patients reported taking a total of 378 medications (mean 7.6 per patient, SD 4.8, range 1-19); 75% (282) of these were prescription medications. The mean number of prescription medications per patient, based on the interview, was 5.6 (SD 4.2, range 0-16), and the mean number of active prescription medications per patient from the PIP profile was 4.5 (SD 4.3, range 0-18) p < 0.001) (Table 1).

Table 2. Discrepancies in Prescription Medications between 4-Month PIP Profile and BPMH

Type of Drug No. (%) of Discrepancies

Mean per Patient ± SD Range


Regular drugs
85 (84)
As-needed drugs
16 (16)


1.7 ±
1.7 0-6 0.3
± 0.6 0-2


Total 101


2.0 ±
2.3 0-6

BMPH = Best Possible Medication History, PIP SD = standard deviation.

=
Pharmaceutical Information Program,

A total of 101 prescription medication discrepancies were identified between the PIP profile and the BPMH. Eleven (22%) of the 50 patients had complete agreement between their PIP profile and the prescription medications they reported taking before admission, but 39 patients (78%) had one or more discrepancies involving a prescription medication. A mean of 2.0 (SD 2.3, range 0-6) prescription discrepancies were identified per patient (Table 2).