Discrepancies in the use of medications - Their extent and predictors in an out-patient practice

Background: Misuse of medications is a major cause of morbidity and mortali ty. Few studies have examined the frequency of, and factors associated with , discrepancies between what doctors prescribe and what patients take in ac tual practice. Patients and Methods: Patients' medication bottles and their reported use o f medications were compared with physicians' records of outpatients seen be tween November 1997 and February 1998 in a private practice affiliated with an academic medical center in Boston, Mass. Three hundred twelve patients from the practices of 5 cardiologists and 2 internists who were returning f or their routine follow-up visits were included. Main Outcome Measure: The presence of discrepancies based on comparing medi cation bottles with medical records. Results: Discrepancies were present in 239 patients (76%). The 545 discrepa ncies in these patients were the result of patients taking medications that were not recorded (n = 278 [51%]); patients not taking a recorded medicati on (n=158 [29%]), and differences in dosage (n=109 [20%]). Overall, discrep ancies were randomly distributed among different drugs and discrepancy type s with no discernible pattern. On multivariate analysis, patient age and nu mber of recorded medications were the 2 most significant predictors of medi cation discrepancy. Conclusions: Discrepancies among recorded and reported medications were com mon and involved all classes of medications, including cardiac and prescrip tion drugs. Older age and polypharmacy were the most significant correlates of discrepancy. The pervasiveness of discrepancies can have significant he alth care implications, and action is urgently needed to address their caus es. Such action would likely have a positive impact on patient care.