Medication Reconciliation Service in Hospitalized Patients with Infectious Diseases during Coronavirus Disease 2019 pandemic: A Prospective Observational Study

INTRODUCTION: To determine the prevalence and type of medication discrepancies and factors associated with unintentional discrepancies, and identify the rate of hospital readmission and emergency service visit within 30 days after discharge among hospitalized patients with infectious diseases and receiving clinical pharmacist-led medication reconciliation during the Coronavirus Disease 2019 pandemic.
METHODS: This observational study was conducted in the internal medicine and infectious diseases wards of a tertiary university hospital between July 2020 and February 2021 among hospitalized adult patients with any infectious diseases. Medication reconciliation service [including patient counseling]) was provided in-person or by telephone. The number and type of medication discrepancies detected during the medication reconciliation services, the acceptance rate of pharmacist’s recommendation, and factors associated with having at least one unintentional medication discrepancy at admission were evaluated. At follow-up, hospital readmission and emergency service visit within 30 days after discharge was assessed by telephone.
RESULTS: Among 146 patients, 84 patients (57.5%) had at least one unintentional discrepancy at admission. Only three unintentional discrepancies were determined in three patients at hospital discharge. All the pharmacist’s recommendations for medication discrepancies were accepted by the physicians. Having COVID-19 (OR=2.25, 95% CI: 1.15-4.40; p<0.05), being high risk for medication error (OR=2.01, 95% CI: 1.03-3.92; p<0.05), and higher number of medications used at home (OR=1.41, 95% CI: 1.23-1.61; p<0.001) were associated with having at least one unintentional discrepancy at admission. The rates of 30-day hospital readmission, and admission to emergency medical service were 12.3% and 15.8%, respectively.
DISCUSSION AND CONCLUSION: Medication reconciliation service provided by in-person or by telephone was useful to detect and solve unintentional medication discrepancies during the COVID-19 pandemic.