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Pharmacist-led interdisciplinary medication reconciliation using comprehensive medication review in gynaecological oncology patients: a prospective study
  1. Heeyoun Son1,2,
  2. Jeongmee Kim2,
  3. Caroline Kim3,
  4. Jonathan Ju4,
  5. Youngmee Lee2,
  6. Sandy Jeong Rhie5
  1. 1Graduate School of Clinical Health Sciences, Ewha Womans University, Seoul, Republic of Korea
  2. 2Department of Pharmacy, Samsung Medical Center, Seoul, Republic of Korea
  3. 3School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
  4. 4Albany College of Pharmacy and Health Sciences, Albany, New York, USA
  5. 5College of Pharmacy & Division of Life and Pharmaceutical Sciences and Graduate School of Clinical Health Sciences, Ewha Womans University, Seoul, Republic of Korea
  1. Correspondence to Professor Sandy Jeong Rhie, College of Pharmacy & Division of Life and Pharmaceutical Sceinces and Graduate School of Clinical Health Sciences, Ewha Womans University, 52 ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea; sandy.rhie{at}


Objectives Medication reconciliation is a key part of transitional care. This study examined the implementation of a pharmacist-led medication reconciliation programme for short-term hospitalised patients and explored the barriers and benefits.

Methods A prospective study was conducted in patients admitted to a gynaecological oncology department. Medications were reconciled on admission using a ‘comprehensive medication review (CMR)’ strategy. Patients received a reminder text message and were asked to bring their medications a day before admission for scheduled chemotherapy. Upon admission, a pharmacist reviewed patients' admission prescriptions and home medications, including non-prescription medications, based on clinical status and laboratory test results. Drug-related problems and unused or expired medications were assessed. Satisfaction with the CMR service and reasons for non-compliance were surveyed by an individual interview. The cost of the unused or expired medications was calculated based on the average drug acquisition cost.

Results Sixty-four interventions in 95 patients were performed during the study—namely, correction of treatment duration (34 cases, 53.1%), recommendation of medications for untreated indications (18 cases, 28.1%), correct drug selection (5 cases, 7.8%), discontinuation of duplicate medications (4 cases, 6.3%), correction of dose, provision of alternatives for drug–drug interactions, unintended omissions (1 case each, 1.6%). The difference in the cost of unused or expired drugs before and after programme implementation was about US$1700.

Conclusions Pharmacist-led medication reconciliation targeting short-term hospitalised patients improved drug use, prevented medication waste and reduced healthcare costs.

  • medication reconciliation
  • hospitalized patients
  • pharmacists
  • comprehensive medication review
  • gynecologic oncology

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