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Background <p>While medication reconciliation (MedRec) is a standard practice in many countries, it is not yet established in Korea. To bridge this gap, we introduced and evaluated a multidisciplinary MedRec service in older adults undergoing thoracic surgery.</p> Methods <p>This single-center prospective study compared the MedRec service (216 patients, September 2022–August 2023) with the usual care group (108 patients, December 2021–April 2022) in older adults undergoing thoracic surgery who were on chronic medication. In the MedRec service, pharmacists obtained the best possible medication history (BPMH) upon admission for use in patient care, unlike usual care, where BPMH was documented post-discharge. Outcomes measured included medication discrepancies at admission and discharge, drug-related problems (DRPs), healthcare visits (emergency department, outpatient clinic and unplanned readmission) within one-month after discharge.</p> Results <p>Medication discrepancies were significantly lower in the intervention group than in the control group at both admission (62.0% vs. 2.8%, <i>p</i> &lt; 0.05) and discharge (46.3% vs. 0.9%, <i>p</i> &lt; 0.05). The incidence of DRPs was also lower in the intervention group within the first month post-discharge (32.4% vs. 14.8%, <i>p</i> &lt; 0.05). However, no significant differences were noted in the rates of emergency department visits (6.5% vs 4.6%, <i>p</i> = 0.66) or unplanned readmissions (3.7% vs 6.5%, <i>p</i> = 0.44). In the intervention group, 887 interventions were performed at admission and 88 interventions at discharge, with acceptance rates of 98.8% and 96.6%, respectively.</p> Conclusion <p>The multidisciplinary MedRec service effectively reduced medication discrepancies and DRPs during care transitions. Furthermore, it underscored the importance of pharmacist-led counseling in establishing BPMH and the positive impact of multidisciplinary approach in enhancing medication safety during these transitions.</p> Trial registration <p>This study was registered with the Clinical Research Information Service [KCT0006813].</p>

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Impact of multidisciplinary medication reconciliation service in older adult patients undergoing thoracic surgery (MERITS) on reducing medication discrepancies: a prospective, controlled, before-and-after study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月26日

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  • Soyoung Park,
  • A Jeong Kim,
  • Hyunwoo Chae,
  • Kyu-Nam Heo,
  • Yookyung Kim,
  • Jeong Yeon Seok,
  • Subin Yoon,
  • Sung Hwan Kim,
  • Yoo Jin Jung,
  • Ji Hyeon Park,
  • Bubse Na,
  • Kwon Joong Na,
  • Samina Park,
  • In Kyu Park,
  • Chang Hyun Kang,
  • Yoon Sook Cho,
  • Young Tae Kim,
  • Hyun Joo Lee,
  • Ju-Yeun Lee

摘要

Background

While medication reconciliation (MedRec) is a standard practice in many countries, it is not yet established in Korea. To bridge this gap, we introduced and evaluated a multidisciplinary MedRec service in older adults undergoing thoracic surgery.

Methods

This single-center prospective study compared the MedRec service (216 patients, September 2022–August 2023) with the usual care group (108 patients, December 2021–April 2022) in older adults undergoing thoracic surgery who were on chronic medication. In the MedRec service, pharmacists obtained the best possible medication history (BPMH) upon admission for use in patient care, unlike usual care, where BPMH was documented post-discharge. Outcomes measured included medication discrepancies at admission and discharge, drug-related problems (DRPs), healthcare visits (emergency department, outpatient clinic and unplanned readmission) within one-month after discharge.

Results

Medication discrepancies were significantly lower in the intervention group than in the control group at both admission (62.0% vs. 2.8%, p < 0.05) and discharge (46.3% vs. 0.9%, p < 0.05). The incidence of DRPs was also lower in the intervention group within the first month post-discharge (32.4% vs. 14.8%, p < 0.05). However, no significant differences were noted in the rates of emergency department visits (6.5% vs 4.6%, p = 0.66) or unplanned readmissions (3.7% vs 6.5%, p = 0.44). In the intervention group, 887 interventions were performed at admission and 88 interventions at discharge, with acceptance rates of 98.8% and 96.6%, respectively.

Conclusion

The multidisciplinary MedRec service effectively reduced medication discrepancies and DRPs during care transitions. Furthermore, it underscored the importance of pharmacist-led counseling in establishing BPMH and the positive impact of multidisciplinary approach in enhancing medication safety during these transitions.

Trial registration

This study was registered with the Clinical Research Information Service [KCT0006813].