Reviewer ’s report  
 
Title: Prevalence of medication discrepancies in patients with cirrhosis: a pilot study  
 
 
Version: 0 Date: 22 Dec 2015  
 
 
Reviewer: Barbara  Valdivia -Correa  
 
 
Reviewer's report:  
 
 
1. Although the study was conducted in an outpatient clinic rather than a referral o tertiary 
medical center, which supp orts its generalizability, it is limited by its single -center nature.  
 
2. Patients referred to a hepatology outpatient clinic may have higher levels of education and 
knowledge about cirrhosis disease self -management, so it would be important to evaluate 
educational background in this population, as well as formally asses level of education and 
cognitive function of each patient (in this particular setting, the grade and severity of 
encephalopathy before they answered the questionnaire).  
 
3. Medication data was gathered from multiple sources (not only the patient), which included 
family members; therefore each patient is questioned in a non -equality status.  
 
4. The study included a significant percentage of patients with decompensated cirrhosis (40%), 
meaning  that these patients have more shifts in their medications (especially dosing) within a 
short span of time that could affect its adherence in a positive o negative fashion.   
 
5. A comprehensive patient and medical record review on medication characteristi cs is 
important, outpatient hepatology clinics (as in this case) lack an updated and verified patient´s 
medication list, so as much as the study relied on patient´s answers, it also subjectively relied on 
GPs and specialists for these information. Aditiona lly, acceptance of the pharmacist - acquired 
medication list could also be questioned.  
 
6. Other studies (Patterns and predictors of medication discrepancies in primary care. Coletti, et 
al. Journal of Evaluation in Clinical Practice, 2015) suggest that add ressing emotional 
functioning and behavioral variables might best understand and solve medication adherence in 
chronic diseases such as cirrhosis. Future studies should rate medication adherence using 
objective indicators rather than relying on patient sel f-report and obtaining patient -specialist 
agreement on medications before assessing adherence.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from 
an organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the  future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I  declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests . 
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manus cript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://cr eativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the jo urnal  
Reviewer ’s report  
 
Title: Prevalence of medication discrepancies in patients with cirrhosis: a pilot study  
 
 
Version: 0 Date: 22 Dec 2015  
 
 
Reviewer: Barbara  Valdivia -Correa  
 
 
Reviewer's report:  
 
 
1. Although the study was conducted in an outpatient clinic rather than a referral o tertiary 
medical center, which supp orts its generalizability, it is limited by its single -center nature.  
 
2. Patients referred to a hepatology outpatient clinic may have higher levels of education and 
knowledge about cirrhosis disease self -management, so it would be important to evaluate 
educational background in this population, as well as formally asses level of education and 
cognitive function of each patient (in this particular setting, the grade and severity of 
encephalopathy before they answered the questionnaire).  
 
3. Medication data was gathered from multiple sources (not only the patient), which included 
family members; therefore each patient is questioned in a non -equality status.  
 
4. The study included a significant percentage of patients with decompensated cirrhosis (40%), 
meaning  that these patients have more shifts in their medications (especially dosing) within a 
short span of time that could affect its adherence in a positive o negative fashion.   
 
5. A comprehensive patient and medical record review on medication characteristi cs is 
important, outpatient hepatology clinics (as in this case) lack an updated and verified patient´s 
medication list, so as much as the study relied on patient´s answers, it also subjectively relied on 
GPs and specialists for these information. Aditiona lly, acceptance of the pharmacist - acquired 
medication list could also be questioned.  
 
6. Other studies (Patterns and predictors of medication discrepancies in primary care. Coletti, et 
al. Journal of Evaluation in Clinical Practice, 2015) suggest that add ressing emotional 
functioning and behavioral variables might best understand and solve medication adherence in 
chronic diseases such as cirrhosis. Future studies should rate medication adherence using 
objective indicators rather than relying on patient sel f-report and obtaining patient -specialist 
agreement on medications before assessing adherence.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from 
an organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the  future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I  declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests . 
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manus cript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://cr eativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the jo urnal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Prevalence of medication discrepancies in patients with cirrhosis: a pilot study  
 
 
Version: 0 Date: 22 Dec 2015  
 
 
Reviewer: Barbara  Valdivia -Correa  
 
 
Reviewer's report:  
 
 
1. Although the study was conducted in an outpatient clinic rather than a referral o tertiary 
medical center, which supp orts its generalizability, it is limited by its single -center nature.  
 
2. Patients referred to a hepatology outpatient clinic may have higher levels of education and 
knowledge about cirrhosis disease self -management, so it would be important to evaluate 
educational background in this population, as well as formally asses level of education and 
cognitive function of each patient (in this particular setting, the grade and severity of 
encephalopathy before they answered the questionnaire).  
 
3. Medication data was gathered from multiple sources (not only the patient), which included 
family members; therefore each patient is questioned in a non -equality status.  
 
4. The study included a significant percentage of patients with decompensated cirrhosis (40%), 
meaning  that these patients have more shifts in their medications (especially dosing) within a 
short span of time that could affect its adherence in a positive o negative fashion.   
 
5. A comprehensive patient and medical record review on medication characteristi cs is 
important, outpatient hepatology clinics (as in this case) lack an updated and verified patient´s 
medication list, so as much as the study relied on patient´s answers, it also subjectively relied on 
GPs and specialists for these information. Aditiona lly, acceptance of the pharmacist - acquired 
medication list could also be questioned.  
 
6. Other studies (Patterns and predictors of medication discrepancies in primary care. Coletti, et 
al. Journal of Evaluation in Clinical Practice, 2015) suggest that add ressing emotional 
functioning and behavioral variables might best understand and solve medication adherence in 
chronic diseases such as cirrhosis. Future studies should rate medication adherence using 
objective indicators rather than relying on patient sel f-report and obtaining patient -specialist 
agreement on medications before assessing adherence.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from 
an organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the  future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I  declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests . 
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manus cript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://cr eativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the jo urnal  
assistant