Table 3 Potential clinical implications of medication discrepancy detected and resolved from baseline to 6-month post-GEI by the principal investigator

Total number of medication discrepancies

139

112

26

36

14

31

Omission of medication

Therapeutic failure

Omission of medication for diabetes

13 (9.4)

3 (2.7)

0.001*

2 (7.7)

2 (5.6)

1.000

0(0.0)

1 (3.2)

0.617

Omission of antihypertensives

11 (7.9)

1 (0.9)

0(0.0)

0(0.0)

1 (7.1)

2 (3.6)

Suboptimal medication therapy

Omission of key medication

18 (12.9)

14 (12.5)

1.000

3 (11.5)

6 (16.7)

0.490

2 (14.3)

7 (22.6)

0.158

Poor quality of care

Medication discontinued by patient

23 (16.5)

14 (12.5)

0.384

2 (7.7)

5 (13.9)

0.438

1 (7.1)

4 (12.9)

0.361

Possible increased risk of cardiovascular disease

Omission of Aspirin/Clopidogrel

14 (7.0)

7 (3.9)

0.028*

1 (1.7)

2 (3.3)

0.618

0 (0.0)

2 (3.6)

0.242

Omission of statins

10 (5.0)

2 (1.1)

0 (0.0)

1 (1.6)

0 (0.0)

1 (1.8)

Different dose/frequency of medication

Therapeutic failure

Too low dose of medication(s)

8 (5.8)

16 (14.2)

0.034*

2 (7.7)

2 (5.6)

1.000

0 (0.0)

0 (0.0)

c

Adverse drug reaction

Dose-related adverse drug reactions

5 (3.6)

9 (8.0)

0.174

3 (11.5)

2 (5.6)

0.668

1 (7.1)

1 (3.2)

1.000

Toxicity

High dose of digoxin

3 (2.2)

4 (3.6)

0.706

1 (3.8)

0 (0.0)

0.479

0 (0.0)

0 (0.0)

c

Increased medication cost

Higher dose related cost increment

11 (8.0)

24 (21.5)

0.004*

4 (15.4)

3 (8.4)

0.242

4 (28.5)

5 (16.1)

0.412

Duration of medication exceeded

Adverse drug reaction

Prolonged use of NSAID

1 (0.7)

1 (0.9)

1.000

0 (0.0)

1 (2.8)

1.000

0 (0.0)

0 (0.0)

c

Safety

Proton pump inhibitor prolonged use

2 (1.4)

1 (0.9)

1.000

3 (11.5)

0 (0.0)

0.106

1 (7.1)

0 (0.0)

0.489

Substitution of prescribed medication by patients

Adverse drug reaction

Aspirin substituted for Clopidogrel

2 (1.4)

0 (0.0)

0.503

0 (0.0)

1 (2.8)

1.000

0 (0.0)

2 (6.4)

0.495

Therapeutic failure

Biguanide substituted for insulin

1 (0.7)

1 (0.9)

1.000

0 (0.0)

1 (2.8)

1.000

0 (0.0)

0 (0.0)

c

Ineffective therapy

ACEIs substituted for CCBs

0 (0.0)

0 (0.0)

c

0 (0.0)

2 (5.6)

0.496

1 (7.1)

0 (0.0)

0.489

Duplication of medication with different brands

Adverse drug reaction

Took 2 different brands of Metformin

0 (0.0)

1 (0.9)

0.452

0 (0.0)

0 (0.0)

c

1 (7.1)

0 (0.0)

c

Toxicity

Took 2 brands of digoxin

4 (2.9)

2 (1.8)

0.693

1 (3.8)

1 (2.8)

1.000

0 (0.0)

0 (0.0)

c

Increased medication cost

Higher cost for duplicated drugs

0 (0.0)

0 (0.0)

c

0 (0.0)

0 (0.0)

c

1 (7.1)

0 (0.0)

0.489

Additional medication not prescribed by physician

Dependence

Use of Bromazepam

0 (0.0)

1 (0.9)

0.452

1 (3.8)

0 (0.0)

0.479

1 (7.1)

0 (0.0)

0.489

Increased medication cost

High cost of added medications

6 (4.3)

6 (5.4)

0.775

3 (11.5)

3 (8.3)

1.000

0 (0.0)

4 (12.9)

0.117

Toxicity

Digoxin intake

3 (2.2)

1 (0.9)

0.630

0 (0.0)

1 (2.8)

1.000

0 (0.0)

1 (3.2)

1.000

Adverse drug reaction

Took Nifedipine with Amlodipine

3 (2.2)

4 (3.6)

0.706

0 (0.0)

2 (5.6)

0.496

0 (0.0)

1 (3.2)

1.000

Tolerance

Chronic use of salbutamol

1 (0.7)

0 (0.0)

1.000

0 (0.0)

1 (2.8)

1.000

0 (0.0)

0 (0.0)

c