CLINICAL RESEARCH STUDY Medication Reconciliation and Hypertension Control Stephen D. Persell, MD, MPH, a Stacy Cooper Bailey, MPH, a Joyce Tang, MD, a Terry C. Davis, PhD, b Michael S. Wolf, MA, MPH, PhD a a Division of General Internal Medicine, Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Ill; b Departments of Medicine and Pediatrics, Louisiana State University Health Sciences Center, Shreveport. ABSTRACT BACKGROUND: Discrepancies between the medical record and patient medication list are common. The relationship of discrepancies to chronic disease control has not been established. METHODS: To determine the frequency and type of antihypertensive medication discrepancies between patient-named antihypertensive medications and the medical record, we performed a cross-sectional study of 315 adults with medically treated hypertension from 6 safety-net clinics in 3 states. We determined the association between medication discrepancies and uncontrolled blood pressure (140/90 mm Hg or 130/80 mm Hg if diabetes) using multivariate logistic regression models. RESULTS: Discrepancies were present for 75.2% of patients; 25.7% of patients could not provide the name of any antihypertensive medication they took; 49.5% could name 1 or more antihypertensive medications but had discrepancies between patient-reported antihypertensive medications and those listed in the medical record. Both patients who were unable to name any of their antihypertensive medications and patients with discrepancies between patient-named medications and the medical record were significantly more likely to have uncontrolled blood pressure than patients who named the same medications as the medical record in adjusted analyses, adjusted risk ratios 1.66 (95% confidence interval, 1.31-2.10) and 1.51 (95% confidence interval, 1.11-2.07), respectively. Twelve percent of patients reporting medications took antihypertensive medication that altered potassium metabolism that was not in their medical record. CONCLUSIONS: Among patients at safety-net clinics, inability to name one’s antihypertensive medications and discrepancies between patient-reported medications and the medical record were very common. Both were strongly associated with inadequate hypertension control. Performing medication reconciliation at the point of care may be an important way to identify patients at high risk for inadequate disease control or safety problems. © 2010 Elsevier Inc. All rights reserved. • The American Journal of Medicine (2010) 123, 182.e9-182.e15 KEYWORDS: Ambulatory care; Blood pressure; Errors; Health literacy; Hypertension; Medication discrepancies; Medication reconciliation; Outpatient Medication reconciliation refers to the process of identify- ing the most accurate list of medications taken by a patient, and increasingly it is seen as a major target for health care quality improvement and patient safety. Recent evidence has documented the high prevalence of discrepancies be- tween the medications patients self-report they are taking and those listed in their medical record. Most studies on this topic have examined reconciliation at the time of care tran- sitions such as admission to or discharge from a hospital. 1-5 However, research now shows similar reconciliation prob- Funding: This work was supported by research grants from the Mich- igan Department of Community Health, Pfizer Pharmaceuticals, Inc., and support from the Health Literacy and Learning Program at Northwestern University and Department of Medicine-Pediatrics, Louisiana State Uni- versity Health Sciences Center at Shreveport. Dr. Persell was supported by career development award 1 K08 HS015647-01 from the Agency for Healthcare Research and Quality. Conflict of Interest: Dr. Wolf has received unrestricted research grant funds from Target Corporation and from Pfizer Corporation. No other authors have conflicts of interest. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Authorship: All authors had access to the data and a role in writing the manuscript. Dr. Persell and Dr. Wolf performed the analyses. They take responsibility for the integrity of the data and the accuracy of the data analysis. Requests for reprints should be addressed to Stephen D. Persell, MD, MPH, Division of General Internal Medicine, Northwestern University, 750 N. Lake Shore Drive, 10 th Floor, Chicago, IL 60611. E-mail address: spersell@nmff.org 0002-9343/$ -see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.amjmed.2009.06.027