Evaluation of Pharmacist Involvement in Transitional Care through Medication Reconciliation

Background : Because at the transition of care, such as admission and discharge, unintended medication discrepancies can readily occur, Medication reconciliation (MedRec) is necessary.We performed two MedRec processes in a row, and retrospectively analyzed both results.The objective of this study was to review the direction of pharmacists' intervention to establish the MedRec process based on the results of both activities. Methods :The first MedRec was conducted through consultation at the time of admission, discharge, and outpatient status for patients who participated in the polypharmacy management project organized by the National Health Insurance Service from September 2021 to March 2022.Subsequently, the hospital's own MedRec process was newly established and implemented at the time of admission by using electronic medical records from April to July 2022. Results :As a result of the polypharmacy project, 32 (71 %) of 45 patients were subject to MedRec, and the number of cases was 48.The most frequent reasons were adverse drug reactions (19 %), and duplications (17 %).The rates at the time of admission, discharge, and outpatient status were 69, 13, and 19 %, respectively.As a result of the hospital's own