High Prevalence and Predictors of Medication Reconciliation Errors in Type 2 Diabetes Outpatients with Multimorbidity: A Cross-Sectional Study in Zambia

When a patient moves from one doctor to another, or from a hospital back to their home, there is a critical moment where their medical history must be transferred accurately. This process, known as medication reconciliation, is the act of creating a perfect list of every drug a person is taking and comparing it against the new prescriptions a doctor writes. The goal is simple but vital: to ensure that no medicine is accidentally left out, no dose is changed without reason, and no dangerous interactions occur. In complex cases where a patient has several chronic conditions, like diabetes alongside heart or kidney issues, this task becomes incredibly difficult. Patients often see different specialists for each problem, and if those doctors do not talk to one another, gaps can appear in the treatment plan. These gaps can lead to patients missing doses or taking the wrong amount of medicine, which can cause serious harm. Understanding how often these mistakes happen, and why, is essential for building safer healthcare systems, especially in regions where resources are stretched thin.

In Zambia, researchers set out to measure exactly how common these medication errors are among adults living with type 2 diabetes and at least one other chronic condition. They focused their study at the University Teaching Hospital in Lusaka, the country's largest referral center, where patients with complex health needs are treated daily. The team interviewed 300 patients who were visiting the outpatient clinic. To get the most accurate picture, they did not rely on just one source of information. Instead, they performed a triple-check audit. First, they spoke directly with the patients to build a "best possible medication history," asking about every pill they took, including those bought from private shops or traditional healers. Second, they looked at the prescription the patient was holding at that moment. Third, they reviewed the patient's official paper medical file to see what had been recorded in the past. By comparing these three sources, the researchers could spot any differences or missing information that the patient or the file alone might have missed.

The results revealed a startling reality: medication errors were not rare exceptions but a frequent occurrence. The study found that 70 percent of the patients had at least one error in their medication list. These were not all minor typos; the researchers graded the severity of each mistake. While some were minor, nearly half were moderate, requiring closer monitoring, and about a quarter were serious enough to demand immediate intervention to prevent harm. The most common types of errors were simply leaving a medicine out of the prescription or prescribing a dose that was too low. The drugs most frequently involved were metformin and insulin, the standard treatments for diabetes, as well as medications for blood pressure and cholesterol. The researchers noted that these errors often happened because of "assumed responsibility," a situation where one specialist assumes another doctor is handling a specific drug, but no one actually checks to make sure it is being continued.

The study also identified clear reasons why these mistakes happened. The strongest predictor was the number of chronic conditions a patient had; for every additional health issue a person faced, their risk of a medication error increased significantly. Similarly, the number of different specialist clinics a patient visited played a major role. Patients who saw doctors in multiple departments, such as cardiology, renal care, and neurology, were much more likely to have errors than those who saw fewer specialists. This fragmentation of care meant that communication between doctors was rare; only about 10 percent of patients who visited multiple clinics had any documented proof that their doctors had spoken to each other about their shared medications. Another significant factor was money. The researchers found that some patients intentionally skipped doses or stopped taking medicines because they could not afford them, and this economic barrier was independently linked to errors in their records.

These findings suggest that the problem is not just about individual mistakes by doctors or patients, but about how the healthcare system is organized. In a setting where records are paper-based and doctors work in separate silos, the burden of keeping track of a patient's full medication list falls on no one in particular. The researchers concluded that to fix this, the system needs to change. They proposed practical solutions such as a shared "medication passport" that patients could carry with them to every appointment, ensuring that every doctor sees the same up-to-date list. They also suggested that pharmacists should take a leading role in checking medication histories before patients see the doctor, and that policies need to address the cost of medicines so that affordability does not become a safety hazard. This study provides the first clear benchmark for medication safety in Zambia, showing that while the challenges are significant, the path to improvement lies in better coordination and a focus on the patient's entire journey through the healthcare system.