[The process of bringing medication in line: the additional benefits of a Structured Medication History].

Objective: To determine the additional benefits of a structured history-taking of medication use (SHIM) from patients admitted to a geriatric ward for obtaining a complete and accurate list of medication used at home, in comparison to an unstructured medication history-taking by the resident physician.

Design: Prospective, observational.

Method: The SHIM, a standardized questionnaire, was used for history-taking from patients admitted to the geriatric ward, and often from their caregivers, too. The number and type of discrepancies were noted between this medication history and the medication history obtained by the resident physician at admission as noted on the medical chart. Discrepancies were assessed for clinical relevance.

Results: The SHIM was used for 47 patients with a mean age of 84.4 years. At least one discrepancy was found in all patients. Comparison of the SHIM to the medication history obtained by the resident physician revealed 4.2 discrepancies per patient on average. Omission of medication in the history taken by the resident was the most common discrepancy. 66% of all discrepancies were considered as potentially clinically relevant; in 19% of the patients this actually resulted in a moderate degree of discomfort or clinical deterioration. The number of discrepancies was statistically significantly associated with the use of a higher number of medications and with the use of 'over the counter' (OTC) medications.

Conclusion: The SHIM provides a better insight into the actual use of medication by the patient than history taking of medication use by the resident at admission.