Table 4.

Clinical Significance of Medication Discrepancies Assessed Independently by Two Pharmacists

Significance of Medication Discrepancy	No. of Discrepancies Observed at Baseline (n, %)	Resolved at Follow-Up (n, %)a	Examples
Unlikely to result in an adverse outcome	93 (55.4)	19/87 (21.8%)	Atorvastatin – GP directions are 1 tablet at night, participant takes 1 in the morning Lubricating eye drops – GP list states three times daily, participant uses as needed Metformin extended release – GP list states 1g twice daily, participant takes 2g daily
Possibly will result in an adverse outcome	39 (23.2)	11/27 (40.7%)	Empagliflozin on GP list, ceased during hospital admission due to declining renal function Paracetamol sustained release not on GP list, participant takes regularly twice daily for osteoarthritis pain Simvastatin listed twice on GP list as two different brand names, may result in unintentional double dosing
Probably will result in an adverse outcome	36 (21.4)	18/30 (60.0%)	Glimepiride on GP list, recently ceased due to a hypoglycaemic episode while driving Short acting insulin not on GP list, participant receives 3 to 10 units with each meal Nebivolol not on GP list, previously commenced by consultant physician
TOTAL	168 (100)	48/144 (33.3%)

Note: ^aData not available for all participants at follow-up.

Abbreviation: GP, general medical practitioner.