Evaluation of an Educational Strategy to Improve Medication Reconciliation in Ambulatory Care

Abstract

Introduction. Improper medication reconciliation can result in inaccurate medication lists which can lead to adverse events including hospitalizations. Interventions targeting medication reconciliation have had varying levels of success. To improve medication reconciliation practices in our ambulatory care clinics, we developed an educational program for clinic personnel. The objective of this study is to describe the educational program, its implementation in a healthcare system, pharmacist and clinic personnel perception of the program, and its impact on clinic personnel knowledge and practice. Methods. Guided by the Conceptual Model of Implementation Research, we conducted an evaluation of a pharmacist-led educational program on evidence-based practices for medication reconciliation by examining implementation outcomes. The implementation outcomes measured include penetration, fidelity, acceptability, appropriateness, feasibility, and adoption. Data was collected through direct observations, administrative data, pre- and post-surveys, and semi-structured interviews. Results. A total of 37/46 (80%) primary care sites implemented the pharmacist delivered medication reconciliation education from April to June 2021 with representation from each of Geisinger’s regions. Ten (27%) clinic sites completed the medication reconciliation educational program as originally designed, with the remainder adapting the program. A total of 296 clinic personnel completed the pre-survey, while 178 completed the post-survey. There were no statistically significant differences in baseline characteristics between clinic personnel who completed the pre- vs. post-survey. Interviews were completed with 11 clinic personnel who attended the educational program and 4 pharmacists who delivered the educational program. All clinic personnel interviewed felt satisfied with the educational program and felt it was appropriate since it directly impacted their job. While clinic personnel felt the educational program was acceptable and appropriate, two major concerns were discussed: lack of patient knowledge about their medications and lack of time to complete the medication reconciliation. We found the adherence rate to the elements of the medication reconciliation which were covered in the education program ranged from 0% to 95% in the 55 observations conducted.Conclusion. An educational program for medication reconciliation was found to be acceptable and appropriate but was often adapted to fit site specific needs. Additional barriers affected adoption of best practices and should be addressed in future studies. Trial registration. N/A