Effectiveness of Pre-Consultation Medication Reconciliation Service in Reducing Medication Discrepancies during Transition of Care from Hospital Discharge to Primary Care Setting in Singapore - A Randomised Controlled Trial

Background: Medication discrepancies during care transition are common. Many factors contribute to the risk of medication discrepancies. Despite medication reconciliation service being practiced in the hospital setting, there is limited knowledge on its effectiveness in the primary care setting. Objective: To evaluate the effectiveness of a pre-consultation medication reconciliation service in reducing unintentional medication discrepancies in patients who are transitioning from hospital to primary care. Methods: A multi-centre, randomised controlled trial in 3 Singapore public sector primary care clinics was conducted.189 patients aged ≥ 21 years, with ≥ 5 chronic medications and on first follow-up visit to primary care clinics for chronic disease management after recent hospital discharge were randomly assigned to receive either a pharmacist-led MRS prior to physician consultation or usual care. Post-consultation medication reconciliation was subsequently conducted for both groups. Results: Post-consultation unintentional medication discrepancies were significantly lower in the intervention compared to the control group (15.8% versus 57.4% respectively, p<0.001). Pre-consultation medication reconciliation is effective in reducing unintentional medication discrepancies (OR 7.74 (95% CI 3.72 to 16.13). Omission of drug was the most common type of medication discrepancy (35.8%). The 30-day rehospitalisation rate was 5.4%. 30- day medication adherence was significantly higher compared to baseline (mean MMAS-8 score of 7.25 versus 6, p<0.001). Conclusion: Medication discrepancies posed as potential risks to patient safety. With the findings of this research and the recommendations of local and international medication safety committees, medication reconciliation service should be provided for all patients who transit from hospital to primary care.