Medication reconciliation in oncological patients: A randomized clinical trial

Abstract

BACKGROUND: Medication reconciliation is considered to be an important strategy for increasing the safety of medication use. However, few studies have been carried out showing the effect of a medication reconciliation program on the incidence of reconciliation errors (REs) in oncological patients treated in the outpatient setting. OBJECTIVE: To measure the effect of a medication reconciliation program on the incidence of reconciliation error that reached the patient (RERP) in cancer patients receiving chemotherapy as outpatients. METHODS: A randomized, prospective, controlled study was carried out to identify the proportion of patients with at least 1 RERP. Medication reconciliation (intervention group) was compared with standard practice (control group) in patients starting new chemotherapy and who were receiving at least 1 home medication before the start of chemotherapy. A prespecified analysis of factors capable of influencing the occurrence of RE in oncological patients was also carried out. RESULTS: A total of 147 patients were included (76 in the intervention group and 71 controls) in this study. There were 3 (4[%]) patients with RERP (primary endpoint) in the intervention group and 21 (30[%]) patients in the control group (relative risk [[]RR] = 0.13, 95[%] CI = 0.04-0.43; P = 0.0009). The prespecified analysis of the effects of the Eastern Cooperative Oncology Group performance status (ECOG), Charlson Comorbidity Index score, and degree of poly-medication upon the number of patients with RE showed the Charlson Comorbidity Index to be unrelated to RE occurrence. However, the risk of RE was greater in patients with ECOG = 2 (RR = 2.18, 95[%] CI = 1.4-3.4; P = 0.018) and among patients with major poly-medication (RR = 2.49, 95[%] CI = 1.52-4.09; P < 0.001). CONCLUSIONS: Medication reconciliation results in a marked decrease in RERP in cancer patients. The factors that may influence RE occurrence in oncological patients have not been fully established, although parameters such as the degree of poly-medication and performance status may play a role.