Enhancing Medication History Accuracy in a Tertiary Hospital: Pharmacist‐Led Counseling With Nationwide Medication History Sharing Program Versus Conventional Methods

Aims: Medication discrepancies during transitions of care pose substantial risks, particularly in older patients receiving complex medication regimens. Obtaining the best possible medication history (BPMH) is crucial to minimize this risk. This study aimed to evaluate the effectiveness of a pharmacist‐led BPMH using various information sources including a nationwide medication history sharing program compared to conventional interviews in a tertiary hospital setting. In addition, we identified factors contributing to medication inaccuracies. Methods: A single‐center prospective study involving older patients scheduled for thoracic surgery at a tertiary hospital was conducted. Medication histories obtained through conventional interviews during the initial assessment on admission were compared with those obtained through BPMH by pharmacist‐led interviews. Logistic regression analysis was used to identify factors associated with medication inaccuracies. Results: This study included 216 patients, a significant proportion of whom were experiencing polypharmacy. The pharmacist‐led BPMH approach demonstrated superior accuracy in documenting medication histories, with conventional methods showing inaccuracies in over 70% of the cases. Factors that significantly increased the likelihood of inaccuracies included the number of medications and number of prescribers. Nonoral and as‐needed medications are particularly prone to inaccuracies. Conclusions: Pharmacist‐led BPMH significantly improved medication history accuracy compared to conventional methods, which had inaccuracies in over 70%. It is important to be careful when obtaining BPMH for older adults, particularly those with complex medication regimens, nonoral medications, or PRN medications, to enhance patient safety and reduce medication‐related risks. Trial Registration: Clinical Trial Registry identifier: KCT-006813 .