Table 4.

Medication discrepancies identified during pharmacist home visits following a hospital discharge (n=30)^*

Patient-associated factors	System-associated factors
• Adverse drug reaction or side effects (n=0)	• Prescription with known allergy/intolerance (n=0)
• Intolerance (n=0)	• Conflicting information from different informational sources (n=5)
• Did not fill/need prescription (n=0)	• Confusion between brand versus generic name (n=0)
• Money/financial barriers (n=3)	• Discharge instructions incomplete, inaccurate, or illegible (n=1)
• Intentional nonadherence (n=2)	• Duplication (n=3)
• Nonintentional nonadherence (n=1)	• Incorrect dosage (n=0)
	• Incorrect quantity (n=0)
• Performance deficit (n=0)	• Incorrect label (n=0)
Total 6/30 (20%)	• Cognitive impairment not recognized (n=0)
	• Need for assistance not recognized (n=1)
	Total 10/30 (33.3%)

Notes:

^*Sixteen discrepancies in total identified among 30 patients visited (53.3%). Identified using the Medication Discrepancy Tool for multiple events, Care Transitions Program® (http://www.caretransitions.org/).