Medication discrepancies (ie, differences between what
patients think they should be taking and regimens ordered
by physicians) were common during and after hospital
discharge. Discrepancies differ from problems of
medication adherence (ie, differences between what patients
think they should be taking and what they actually
take) because the problem is one of communication
and documentation rather than patient education or mo-tivation. Discrepancies have serious consequences, including
prolonged periods of overtreatment or undertreatment.
The problem has been demonstrated in recent
studies,9,15,27 including 2 of general medical inpatients
showing discrepancies on hospital admission in 53.6%
and 54.4% of patients,13,28 similar to our finding of discrepancies
in 49%. The magnitude of this problem is only
beginning to be appreciated and to receive attention from
health care agencies. The Joint Commission for Accreditation
of Healthcare Organizations is now mandating
medication reconciliation at the time of hospital admis-sion and discharge,29 although organizations are still struggling
with implementation issues.