Correspondence between Pharmacy and Medical Records in a Family Medical Centre

The purpose of this study was to evaluate the completeness of medical records in documenting long-term medications prescribed by physicians at a family medical centre. Previous studies have found that medical records relating to prescribed medications are frequently incomplete. Pharmacy files and medical records of 101 patients with hypertension, chronic obstructive pulmonary disease, diabetes mellitus and/or asthma were reviewed for information on long-term medications. In only one-half the medical records had accurate information on drug name and dosage been recorded on the front sheet. Drug information was less likely to be recorded for patients taking more than one medication than for patients taking only one medication. The solution to the problem in this setting was to link the pharmacy records to the problem in this setting was to link the pharmacy records to the computerized patient-record system. Information on drug reactions and long-term medications is updated on the patient's medical record each time a new or modified prescription is ordered. While this solution may not be appropriate for other family practices, the findings emphasize the need to update systematically long-term medication lists.