ArticleBMC geriatrics2026
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.
Article in BMC geriatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWhile 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.
methodsThis 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.
resultsMedication 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.
conclusionThe 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 registrationThis study was registered with the Clinical Research Information Service [KCT0006813].
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