Objective <p>This study aimed to investigate the impact of a medication discrepancy management platform on reducing medication discrepancies among elderly patients with polypharmacy and to analyze influencing factors.</p> Methods <p>A total of 110 elderly polypharmacy patients were divided into a control group and an observation group using a random number method, each with 55 participants. The control group received routine management, while the observation group utilized a medication discrepancy management platform. Medication knowledge and adherence before and after intervention were compared between the two groups. Reasons and types of medication discrepancies were statistically analyzed. Patients were divided into a non-discrepancy group and a discrepancy group, with multivariate logistic regression used to analyze factors influencing medication discrepancies among elderly patients with polypharmacy.</p> Results <p>Utilizing a medication discrepancy management platform significantly improved medication knowledge and adherence among elderly patients (<i>P</i> &lt; 0.05). A total of 34 patients (30.91%) experienced at least one medication discrepancy within one-week post-discharge, primarily involving decreased frequency, missed doses, reduction in medication types, and medication substitution. Multivariate logistic regression analysis showed that the use of the medication discrepancy management platform, caregiver involvement, and prescribed discharge medications (7–8 types or ≥ 9 types) were independent factors influencing medication discrepancies in elderly patients (<i>P</i> &lt; 0.05).</p> Conclusion <p>Using a medication discrepancy management platform can effectively reduce medication discrepancies in elderly patients with polypharmacy and improve elderly patients’ adherence to medication. Expanding the platform’s use can enhance discharge guidance quality and ensure medication safety.</p>