Participatory Research to Improve Medication Reconciliation for Older Adults in the Community

Abstract

Introduction:

Medication reconciliation, a technique that assists in aligning a care team’s understanding of an individual’s true medication regimen, is vital to optimize medication use and prevent medication errors. Historically, most medication reconciliation research has focused on institutional settings and transitional care, with comparatively little attention given to medication reconciliation in community settings. To optimize medication reconciliation for community-dwelling older adults, health care professionals and older adults must be engaged in co-designing processes that create sustainable approaches.

Methods:

Academic researchers, older adults, and community- and health system-based health care professionals engaged in a participatory process to better understand medication reconciliation barriers and co-design solutions. The initiative consisted of two participatory research approaches: 1) Sparks Innovation Studios, which synthesized professional expertise and opinions, and 2) a Community Consultation Studio with older adults. Input from both groups informed a list of possible solutions and these were ranked based on evaluative criteria of feasibility, person-centeredness, equity, and sustainability.

Results:

Sparks Innovation Studios identified a lack of ownership, fragmented healthcare systems, and time constraints as the leading barriers to medication reconciliation. The Community Consultation Studio revealed that older adults often feel dismissed in medical encounters and perceive poor communication with and among providers. The Community Consultation Studio and Sparks Innovation Studios resulted in four highly-ranked solutions to improve medication reconciliation: 1) support for older adults to improve health literacy and ownership; 2) ensuring medication indications are included on prescription labels; 3) trainings and incentives for front-line staff in clinic settings to become champions for medication reconciliation; and 4) electronic health record improvements that simplify active medication lists.

Conclusion:

Engaging community representatives with academic partners in the research process enhanced understanding of community priorities and provided a practical roadmap for innovations that have the potential to improve the well-being of community-dwelling older adults.

INTRODUCTION

Lack of care coordination in a fragmented healthcare system fraught with polypharmacy results in medication errors, suboptimal medication use, and harm.^{1, 2} Complex medication regimens are a burden for individuals and their care partners.^{3, 4} As the aging American population grows, comprehensive management of medications is vital to the well-being of older adults and their families.²

Medication reconciliation is a proven method to identify and resolve medication discrepancies, or differences in the contents of a medication list at the individual-level and between providers at different institutions.^{5, 6} Medication reconciliation is the process of identifying the most accurate list of all medications that a patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider.^{7, 8} Medication reconciliation also includes a conversation between an individual and their health care team to determine which medications – both prescription and over-the-counter -- are actually being taken.^{8, 9} The medication reconciliation process can reduce medication-related errors, drug therapy problems and their associated harms.^10–14

Although accurate medication reconciliation has been recognized as a key intervention to promote patient safety, there is a dearth of research to guide how best to conduct timely and accurate medication reconciliation.^{11, 15–18} To date, the vast majority of research on medication reconciliation has occurred in acute and long term care settings, with a scarcity of studies focused on primary care. Additionally, there is limited research that prioritizes the perspectives of older adults who have higher rates of multimorbidity and polypharmacy, and thus incur higher risk for medication-related problems.¹⁴ Moreover, Black Medicare beneficiaries are more likely to report being in relatively poor health, to report trouble obtaining needed care, and have higher prevalence rates of some chronic conditions, all factors that may contribute to medication-related problems.¹⁹

Given the limitations of the existing literature, more research is needed to inform best practices for medication reconciliation in diverse community settings. In particular, studies that intentionally incorporate historically underrepresented voices to advance health equity at the intersection of age and race are urgently needed.²⁰ Many questions remain regarding medication reconciliation in the community setting: What barriers exist to its delivery? How can medication reconciliation be more person-centered?²¹ How do older adults perceive and participate in medication reconciliation? How can medication reconciliation be a means to address healthcare disparities and equity?

Community-engaged approaches are an essential method to generate novel, sustainable innovations for pressing clinical and population health issues.²² In community-engaged approaches, patients, community members, providers, and other informants with expertise garnered through lived-experience partner in the research process.²³ Such participatory approaches hold promise in co-designing equitable solutions to healthcare issues, like medication reconciliation among older adults. The purpose of this report is to describe the findings from a community-engaged approach for building novel solutions to improve medication reconciliation among racially diverse older adults.

METHODS

Overview

From 2015-2020, the Duke Geriatric Workforce Enhancement Program (GWEP) – a grant-funded workforce development program – partnered with Senior PharmAssist, a community-based organization focused on the medication and insurance needs of older adults in Durham, North Carolina.^{24, 25} During this time, it was determined that medication reconciliation for community-dwelling under-resourced older adults was a pressing concern and the Durham Medication Reconciliation Initiative was formed. The Initiative’s leadership team included representatives from Senior PharmAssist, several academically-affiliated providers, and a university-based community-engaged research group, the Community Engaged Research Initiative (CERI) within the Duke Medical Center Clinical and Translational Science Institute (CTSI).

This leadership team planned and conducted a series of engagement sessions with the goal of co-designing solutions to improve medication reconciliation for older adults in the community (Figure 1). The leadership team was intentional in trying to operationalize a racial equity framework and ensure that any solutions were geared towards the racially diverse Durham community, which has a higher proportion of Black older adults (35%) compared to national averages (9%).²⁶

Figure 1.

Order of activities for the participatory research approach. Abbreviations: GWEP = Geriatric Workforce Enhancement Program; SPA = Senior PharmAssist; CERI = Community Engaged Research Initiative.

Two complementary approaches to gathering information from collaborators were used: Community Consultation Studios (CCS; 1 session) and Sparks Innovation Studios (SIS; 3 sessions). SIS are a series of facilitated brainstorming (i.e., co-design) sessions intended to “spark” new innovations and foster community-researcher partnerships to build and test solutions in response to community health priorities and concerns. CCS are listening sessions with community informants with lived-experience (e.g. patients) designed to glean input on research development or implementation to improve person-centeredness and cultural relevance of healthcare research. This approach is ideal for gaining patient input on key community issues but is less well-suited to produce generalizable evidence or achieve thematic saturation on a question of interest.²³

Two complementary groups of experts with the lived experience of receiving or delivering medication reconciliation were invited to participate in four engagement sessions. Community-dwelling adults who self-identified as having multiple prescriptions to manage their health conditions, were aged 65 and older, and represented the racial diversity of the Durham community were invited to participate in a CCS session. A second set of experts was selected to include an interdisciplinary group of community and academic health care professionals, translational science researchers, and a racial equity researcher. The health care professionals in the SIS group had demonstrated expertise in geriatrics and were practicing in the same local area as the CCS participants. These experts participated in three SIS sessions, which consisted of 90-minute facilitated meetings that were each held approximately a month apart. The order of the four sessions was deliberately chosen so that the second and third SIS occurred after the CCS session, to allow SIS participants to incorporate findings from the CCS with their own professional perspectives and expertise on medication reconciliation. The specific actions taken during each session are detailed below.

Following COVID-19 distancing protocols, all Studios were conducted via recorded video conferencing under an exempt protocol as determined by the Duke University Health System IRB. Older adult community experts were compensated $50 and community clinicians were offered the same compensation for participation.

Sparks Innovation Studio Session 1:

The first SIS included a facilitated conversation utilizing group generative methods²⁷ (i.e. modified 1-2-4-all process) to determine barriers and facilitators to medication reconciliation from the perspective of health care professionals and researchers (Supplementary Table S1). This led to the creation of a list of potential priorities when addressing community-based medication reconciliation problems. After SIS 1, the priorities were distributed to all attendees to rank using a modified forced-ranking prioritization method our group has used in past community-engaged research.^{28, 29} This information was used to inform SIS 2.

Community Consultation Studios (CCS)

The CCS was conducted shortly after the first SIS session to ensure that the subsequent stages of the research were person-centered and integrated feedback from older adults. The CCS was conducted with community-dwelling older adults in the Durham area who self-identified as having multiple prescriptions to manage their health conditions. The goal of the CCS was to understand how medication reconciliation can be more person-centered. The discussion questions were structured to 1) define the problem and its impact; and 2) gather information on barriers, facilitators, and potential solutions (Supplementary Table S2).

Sparks Innovation Studio Session 2:

The goal of the second SIS was to advance the conversation from SIS 1 towards viable community-driven solutions, to allow participants to incorporate findings from the CCS with their own professional perspectives and expertise on medication reconciliation, and to achieve consensus on the most important proposed medication reconciliation solutions based on CCS participant feedback and results of the priority ranking exercise to help identify the most promising solutions (Supplementary Table S3). The SIS attendees separated into interdisciplinary breakout rooms where they were engaged in a structured brainstorming session addressing the following topics: 1) information needed to address priority; 2) key collaborators to push priority forward; 3) key metrics to define success if priority is achieved; 4) first step in moving priority forward (Supplementary Table S4).

Sparks Innovation Studio Session 3:

The final SIS helped the leadership team further refine the priorities list by using evaluative criteria. To begin the discussion, a racial equity expert provided a brief overview of how team members might operationalize a racial equity framework by considering who is involved in the efforts, who has the authority to make decisions, and where resources might flow. This helped establish a framework for the team to use when assessing possible solutions to improve medication reconciliation in the Durham community.

A medication reconciliation solutions matrix of the top nine solutions generated from SIS 1 and 2 was used to guide the conversation of SIS 3 (Supplementary Table S5). Four evaluative criteria were assessed for each of the nine solutions: feasibility, person-centeredness, racial and age-based equity, and sustainability³⁰ (Supplementary Table S6). In a real-time poll, the Sparks attendees were asked to indicate, “yes” or “no,” if they perceived the potential solution to meet the evaluative criteria standards. The percentage of “yes” votes for each evaluative criterion was calculated and the mean and median for each proposed solution was calculated (Supplementary Table S5). The four solutions with the top mean percentages of “yes” votes were selected as most viable. Given the desire to ensure an equity focus, at least 50% of the SIS participants must have indicated the intervention to address racial and age equity.

RESULTS

The three SIS sessions engaged with a total of 17 racially diverse collaborators representing a range of professional perspectives. The nine CCS participants (age range: 65-73) were majority women and just over half self-identified as Black individuals (Table 1).

Table 1.

Demographics of research participants.

	Participatory Research Approach
	Sparks Innovation Studios (SIS)	Community Consultation Studios (CCS)
Community expert type	Health Care Professionals & Academic Researchers	Older Adult Patients
Number	12 Healthcare Professionals 4 Translational Science Researchers 1 Racial Equity Expert/Researcher	9
Race	9 White 6 Black 2 Asian	5 identifying as Black 4 identifying as White
Sex	6 men 11 women	2 men 7 women
Age range (years)	Not reported	65 - 73
Occupation	Social workers, nurses, nurse practitioners, physician specialists, primary care providers, retail and clinical pharmacists, translational science researchers, and racial-equity expert	Not reported*

^*The occupation of CCS attendees was not collected.

Sparks Innovation Session 1

Clinicians and researchers discussed barriers to, and facilitators of, medication reconciliation (Figure 2). Siloed health systems, inconsistencies in the quality of medication reconciliation between clinic sites and providers, and lack of ownership of the process were identified as potential barriers. There was disagreement as to which providers should “champion” medication reconciliation, and whether responsibility should be delegated based on provider type (primary care versus specialist) or based on which provider sees a patient most frequently. Potential facilitators of successful medication reconciliation included strengthened relationships between health care professionals and patients’ care partners, improved communication and delineation of roles among members of the health care team, standardization of medication reconciliation, and a universal EHR.

Figure 2.

Barriers to and Facilitators of Medication Reconciliation. Legend: red boxes correspond to barriers; green boxes correspond to facilitators of person-centered medication reconciliation. Abbreviations: HCPs = health care professionals; EHR = electronic health record; MA = medical assistant

Community Consultation Studio

We queried the nine older adults who participated in the CCS on the following issues pertaining to medication reconciliation: expectations; accountability; barriers, facilitators, and solutions (Table 2). We summarize findings below.

Table 2.

Exemplar quotes from older adult participants attending the Community Consultation Studio.

Question 1. What are your expectations for medication reconciliation?

“When you are talking about a pharmacy and your personal physician, other specialist, other types of medical services, that’s a lot of different branches…It’s very important for at least one entity in there to have…all of the information together…As far as I’m concerned, I need to know before I take a medication.”

“Every time I go back for an appointment…the [doctors’ office] still have medications listed for me that I have been taken off of. If everyone has this information that has access to Duke MyChart, why is the information not updated on their screen?”

“The pharmacy can’t seem to get it right. They call me every other day to tell me that the old prescription is ready for me to pick up. I have to tell them over and over that I am not on that strength anymore.”

Question 2. Whose responsibility is it to have open and honest conversations with you about your medications and how might you reconcile those medications?

“I think that it’s my primary care physician… [they are] looking at your overall health.”

“I expect the person doing the prescribing to verify against the medications that I already have. I might not see my primary care physician for 6 months after I get a new prescription.”

“I have to be involved because the medicine is going in me.”

Question 3. What are some things that get in the way of a quality medication reconciliation process?

“The attitude of medical people is dismissive. They have 20,000 people complain about what you are going to complain about, they just don’t really pay that much attention anymore.”

“We get embarrassed and don’t want to talk about certain things. That might be a barrier. It’s both my personal pride and not having a trusting relationship with my provider”

Question 4. What are some things that could help to make sure that everyone has a current and correct list of medications in our community?

“Us listing exactly what we have, what we are taking, and how we are taking it. Make a copy and make sure that everyone concerned has it.”

“…make a list and make sure that they have the list…we can share it with our pharmacist if we really trust our pharmacist. But, I don’t have the same pharmacist all the time that knows me.”

Questions 5. If time and money were no option and we know that this issue of medication reconciliation does exist and can have some real consequences for people, how could we fix this problem?

“We would all work together in a group as partners. The provider, the patient, and anyone else that we would have to deal with.”

I like doing the universal chart connection. Sometimes…you have to be out of town…and you are at the mercy of a hospital that you are [not] familiar with. You might have to get medications there and they would need to know also.”

Q1: What are your expectations for medication reconciliation? (expectations)

Overall, most older adults attending the CCS reported that they would expect that at least one entity should have full understanding of their medication and that patients should also take control of knowing their own medications and dosages. Yet, older adults expressed frustrations with medication reconciliation throughout the community continuum of care, including problems with multiple providers, out of date electronic health records, untrained staff conducting medication reconciliation, and pharmacies filling medications incorrectly due to lack of access to updated medication lists.

Q2: Whose responsibility is it to have open and honest conversations with you about your medications and how might you reconcile those medications? (accountability)

CCS participants were split on whose responsibility it is to reconcile medications. Some trusted medical professionals such as primary care providers (PCPs) or any provider who is prescribing new medications. Others believed that since they are seeing multiple providers, it is important to advocate for themselves and to understand their medication regimens. Most older adults attending the CCS agreed that they would like a designated “go-to” person and know if medical professionals are communicating with each other about their medications. Concerns were also raised about privacy and not wanting information about their medications to be unnecessarily available to outside parties. They found Senior PharmAssist,²⁴ a community-based pharmacy assistance organization, and tools such as refrigerator magnets with medication lists for emergency medical services, to be helpful. Many older adults stated it would be helpful if the indication for a medication was listed on the label.

Q3: What are some things that get in the way of a quality medication reconciliation process? (barriers)

The main barriers reported were a perceived lack of time and dismissive attitudes of some providers, which contributed to mistrust. Some shared that they did not feel they could have candid conversations with their providers to tell them how they were truly taking their medications.

Q4: What are some things that could help to ensure that everyone has a current and correct list of medications in our community? (facilitators)

Many of the older adults stated they should keep an updated and detailed copy of their medications. Ideally, participants mentioned a universal electronic health record as an ideal mechanism for communicating medications. Community pharmacists were perceived as helpful. Some older adults shared that they could take more control by adding their own medications to the patient portal in electronic health records; however, technology can sometimes fail to update or be difficult to navigate. They shared that others can also be involved, including staff from insurance companies who call them to create a medication list for them.

Q5: If time and money were no option, how could we fix the medication reconciliation problem? (solutions)

Participants stated more training for providers and medical staff on conducting medication reconciliation, education for patients on their medications and how to use patient portals, teamwork among all parties, and technology such as universal health records would help.

Sparks Innovation Session 2

Following the results from SIS 1 and the CCS, many SIS attendees voiced support for a person-centered approach to the medication reconciliation design process. This approach would incorporate individuals’ needs, previous experiences with the healthcare system, personal motivations, health literacy, and outcomes that matter most to the individual older adult. SIS participants acknowledged that having the older adult guide the conversation by asking more open-ended questions might be challenging, especially with cognitively challenged individuals; however, it puts the ownership on individuals to describe how they are taking their medications. The inclusion of diverse voices in the medication reconciliation development process -- patients, care partners, health care professionals, and experts from other disciplines -- was recognized as essential.

Sparks Innovation Session #3

The final set of priority solutions was determined in SIS #3. The SIS participants’ rank ordering revealed four top interventions to improve medication reconciliation (Supplementary Table S5, Supplementary Figure S1). The following top prioritized solutions below are in no particular order.

Prioritized Solution A: Improve current EHR to facilitate communication between providers, community pharmacists, patients, and care partners.

This solution addresses the barrier of a lack of universal EHR and poor communication between providers. These communication changes could include direct messaging about medication changes between providers and community pharmacists or between providers and care partners. Some felt this intervention would need to be more of a workflow solution rather than an adjustment in the EHR itself. Others felt that they do not have capacity in their workflow for additional EHR messaging but that simplifying the EHR options for medication usage is necessary.

Prioritized Solution B: Include medication indication on prescriptions and on the EHR documentation so that it is included on labels for patients to see.

This solution is designed to increase patient engagement by allowing retail pharmacists to add indications to prescription labels. Participants shared that this is already being done at some locations such as Veteran’s Affairs clinics, skilled nursing facilities, inpatient facilities, and on an outpatient basis for “as needed medications,” but not consistently for other outpatient prescription medications. It may be difficult to implement in situations where a medication is intended for more than one indication and would require all prescribing providers to participate for the solution to be universal.

Prioritized Solution C: Train older adults on medication reconciliation and medication basics to increase health literacy and ownership when possible.

This solution would increase patient engagement and help older adults understand how their medications are being managed, since many older adults reported confusion surrounding the process. This solution aligned with person-centeredness because it addressed the desire of the older adults at the CCS to share ownership in the medication reconciliation process. SIS participants differed on whether the support should focus on navigating technology such as patient portals or on basic medication education. SIS participants noted the importance of race concordance with patients and those trying to help as a means for improving trust and communication.

Prioritized Solution D: Training for medical assistants and other direct care workers to become medication reconciliation champions in clinical settings.

Team-based care approaches have been shown to improve rates of physician-documented medication reconciliation.³¹ In our care context, medical assistants most often perform intake in the ambulatory setting, including vital signs and initial medication reviews. Several SIS participants shared that medical assistants can match medications on medication lists but may need more training to improve the accuracy of the list and to understand when to triage discrepancies or other concerns to the provider or a pharmacist. Training direct care workers to assure the accuracy of the mediation list may provide them with opportunities for professional development and recognition while also freeing up time for providers to focus on medication appropriateness, thus potentially addressing the frustrations that older adults voiced about provider time constraints. In addition to training, healthcare systems need to redesign processes to provide medical assistants with adequate time, resources, and communication tools to conduct medication reconciliation and appropriate recognition and compensation for their work. The SIS participants also discussed engaging Community Health Workers as advocates for medication reconciliation in the community.

DISCUSSION

Our initiative used an innovative approach to elucidate patient, provider, and systems-level barriers that cause fragmented medication reconciliation in the community. We derived solutions by exploring the lived experiences of older adult community members and seeking novel solutions in partnership with community providers and academic researchers. Our participatory research aligns with goals of national primary care organizations in that this practice is a community-oriented model.³²

Based on structured discussions with diverse participants, our research identified several barriers to high-quality, person-centered medication reconciliation for community-dwelling older adults. At the systems level, our participants reported that inefficiencies in the EHR and insufficient communication among different providers and/or pharmacies led to the maintenance of outdated medication lists with inaccuracies and discrepancies. At the level of individual patients and providers, we found that time constraints, dismissive provider attitudes, and lack of trusting provider-patient relationships were all potential contributors to ineffective medication reconciliation. These challenges are likely compounded by the lack of consensus about the extent to which various groups – including primary care providers, specialty providers, pharmacists, and older adults or their care partners – should assume primary responsibility for ensuring the accuracy of an individual’s medication list.

Given that the factors that contribute to sub-optimal medication reconciliation are complex, there is a need for interventions that address multiple barriers to person-centered medication reconciliation. Our research identified several potential solutions, which were evaluated on the basis of feasibility, person-centeredness, equity, and sustainability. As a community-engaged endeavor, the potential solutions that were identified via this process reflected the priorities, resources, and challenges of a specific local context. For example, prioritized solutions A and B arose out of discussions that identified key technological barriers – namely, the lack of interoperability between the record-keeping systems used by prescribers and pharmacists (solution A) and the inconsistent inclusion of medication indications on prescription labels (solution B) – that were, to some extent, specific to the particular EHR and healthcare infrastructure in which the SIS participants were situated. Prioritized solution C – which emphasized the need for increased health literacy among community-dwelling older adults – addressed a problem that is widely applicable to a broad range of communities, although discussions about how this solution might be implemented were necessarily grounded in local, community-specific considerations. In a similar vein, prioritized solution D, which focused on the need for increased training of medical assistants, arose in part out of the recognition – as detailed further below – of the necessity of a team-based solution that explicitly addressed equity considerations in a community where over one-third of all residents identified as Black.³³ Based on these prioritized solutions, the Durham Medication Reconciliation Initiative continues to address medication reconciliation in the Durham community, while incorporating community collaboration and an equity framework as guiding principles. However, given the centrality of local context in this process, the findings of the current study are unlikely to be fully applicable to all other healthcare settings and communities. This highlights a potential limitation of the CCS methodology, which is designed to facilitate community-engaged co-development of solutions on a local level but is less well-suited to produce generalizable evidence to answer broader research questions of interest. Overall, the approach that was utilized in the current study complements but does not obviate the need for systematic research aimed at studying patient-centered medication reconciliation on a larger scale.

Despite the potential limitations of our community-oriented methodology, our approach has a number of key strengths. These include an explicit emphasis on addressing racial and age equity, which has not been addressed in previous research on medication reconciliation.^{14, 20} We intentionally engaged diverse perspectives to shape this project at the CCS and the SIS meetings. As an early part of the process, the voices of CCS participants informed the direction and priorities of the subsequent SIS sessions. As the majority of CCS participants were Black, the barriers and facilitators to medication reconciliation identified by this group present important opportunities to deal with longstanding disparities in care for this population. Additionally, prioritized Solution D, standardized training for medical assistants and other direct care workers, allows for an opportunity to address racial equity if there is race concordance between medical assistants and patients since patient-healthcare provider race concordance has been found to be associated with better communication.^{34, 35} Another potential strength of this solution is that engaging direct care workers as valued members of the healthcare team could enhance professional identity and decrease turnover, which has been identified as a major issue in ambulatory primary care settings.³⁶ Notably, one previous study involving nurses showed that the perception of “mattering” at work – defined as feeling that one has significance in the community and is making a difference in others’ lives – was associated with higher engagement and decreased burnout.³⁷ Importantly, that study showed that participants’ self-perception of mattering at work was enhanced by experiences in which they were able to demonstrate professional competence. In light of these findings, it is hoped that creating opportunities for front-line healthcare workers to develop expertise in the medication reconciliation process could decrease burnout and turnover while also advancing health equity.

Our research successfully utilized a participatory, community-engaged approach – with an explicit emphasis on equity – to identify several potential interventions aimed at improving person-centered medication reconciliation in the outpatient setting. Future studies on medication reconciliation among community-dwelling older adults should seek to evaluate the impact of the developed approaches on perceptions of person-centeredness and engagement, and should continue to embrace an equity framework, patient agency and voice, and integrate an interdisciplinary group of community healthcare professionals as informants in the intervention design process.

Key Points:

1. Structured discussions with community-dwelling older adults demonstrated that current medication reconciliation practices often fail to be person-centered, leaving many older adults unsure about how to use their medications. Inconsistent communication among providers and pharmacies, dismissive provider attitudes, and insufficient time during visits were identified as potential impediments to quality medication reconciliation.

2. Providers identified a number of barriers to accurate medication reconciliation, including problems with the electronic health record, disagreement about which provider(s) should have primary responsibility for medication reconciliation, and difficulty establishing trusting relationships with patients in light of significant time constraints.

3. Evaluation of potential solutions based on feasibility, person-centeredness, equity, and sustainability identified four key interventions with the potential to improve the medication reconciliation process for community-dwelling older adults.

Why does this matter?

Although accurate medication reconciliation has been recognized as an important safeguard against medication errors, there is a paucity of research about the experiences of community-dwelling older adults with medication reconciliation in the ambulatory setting. This study adds a crucial perspective to the existing literature by engaging with the lived experiences of diverse participants – including members of historically marginalized communities – in order to identify barriers to person-centered medication reconciliation and develop equitable solutions.