Medication documentation in a primary care network serving North Carolina medicaid patients: results of a cross-sectional chart review

Olson, Matthew D.; Tong, Gretchen; Steiner, Beat; Viera, Anthony J.; Ashkin, Evan; Newton, Warren P.

doi:10.1186/1471-2296-13-83

Cited by 9 publications

(5 citation statements)

References 25 publications

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“…This was one of the most important risk factors for insufficient medication safety among the investigated units and most likely also for Swedish primary care in general. Updating the medication list in the medical record is often done deficiently, which has been noted previously [ 20 , 21 ]. Medical records that do not accurately reflect the patient’s current medication list are open invitations to possible significant medical errors.…”

Section: Discussionmentioning

confidence: 99%

Safer drug use in primary care - a pilot intervention study to identify improvement needs and make agreements for change in five Swedish primary care units

et al. 2016

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BackgroundThere is an urgent need to improve patient safety in the area of medication treatment among the elderly. The aim of this study was to explore which improvement needs and strengths, relating to medication safety, arise from a multi-professional intervention in primary care and further to describe and follow up on the agreements for change that were established within the intervention.MethodsThe SÄKLÄK project was a multi-professional intervention in primary care consisting of self-assessment, peer-review, feedback and written agreements for change. Data were obtained from five primary care units randomised to the intervention group. Reviewer feedback reports and agreements for change were analysed using content analysis.ResultsStrengths that were identified included a committed leadership, work methods to enhance medication safety and access to consultants. Methods for securing an accurate medication list, knowledge and methods of working of the prescriber and patient’s ability to contribute to medication safety were areas that gave rise to three predesigned categories for improvement needs on a local level. Another category became apparent during the analysis; namely learning from mistakes and from results. In all categories, apparent shortcomings were identified. These included inaccurate medication lists, lack of medication reconciliation, lack of time for follow-up of elderly patients, need for further education in geriatrics and pharmacotherapy and lack of information on indication and maximum dosage. An increased number of medication reviews were among the most common agreements for change seen.ConclusionsThis study identified substantial shortcomings, like poorly updated medication lists, which affected medication safety in the participating Swedish primary care units. Similar shortcomings are most likely present in other primary care units in the country. Working together multi-professionally, including performing medication reviews, could be one way of improving medication safety. On the other hand, the individual physician must possess enough pharmaceutical knowledge and the working conditions must allow time for follow-up of prescriptions. Strengths of the primary care unit, such as successful methods of working, must be taken advantage of. The culture in primary care may affect the ability to successfully implement routines that improve patient safety and reduce risk of medication errors.

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Section: Discussionmentioning

confidence: 99%

Safer drug use in primary care - a pilot intervention study to identify improvement needs and make agreements for change in five Swedish primary care units

et al. 2016

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“…However, an overview of actual medication use is essential for medication reviews. It is known that GPs’ and pharmacists’ medication records and actual intake often mismatch [ 24 , 25 ]. Results from an Australian study showed that medication use obtained by means of a telephone interview had good agreement with those obtained by means of an interview [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Information on actual medication use and drug-related problems in older patients: questionnaire or interview?

et al. 2016

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Background Information on medication use and drug-related problems is important in the preparation of clinical medication reviews. Critical information can only be provided by patients themselves, but interviewing patients is time-consuming. Alternatively, patient information could be obtained with a questionnaire. Objective In this study the agreement between patient information on medication use and drug-related problems in older patients obtained with a questionnaire was compared with information obtained during an interview. Setting General practice in The Netherlands. Method A questionnaire was developed to obtain information on actual medication use and drug-related problems. Two patient groups C65 years were selected based on general practitioner electronic medical records in nine practices; I. polypharmacy and II. C1 predefined general geriatric problems. Eligible patients were asked to complete the questionnaire and were interviewed afterwards. Main outcome measure Agreement on information on medication use and drug-related problems collected with the questionnaire and interview was calculated. Results Ninety-seven patients participated. Of all medications used, 87.6 % (95 % CI 84.7-90.5) was reported identically in the questionnaire and interview. Agreement for the complete medication list was found for 45.4 % (95 % CI 35.8-55.3) of the patients. On drug-related problem level, agreement between questionnaire and interview was 75 %. Agreement tended to be lower in vulnerable patients characterized by C4 chronic diseases, C10 medications used and low health literacy. Conclusion Information from a questionnaire showed reasonable agreement compared with interviewing. The patients reported more medications and drug-related problems in the interview than the questionnaire. Taking the limitations into account, a questionnaire seems a suitable tool for medication reviews that may replace an interview for most patients.

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“…There is a large body of literature demonstrating that patients frequently lack accurate knowledge of their medications 6–9. This problem is compounded by the fact that patients may be prescribed medications by multiple specialists, so even medication lists from family physicians on referrals are frequently inaccurate due to the lack of system-level electronic medical records 10 11. One Canadian study demonstrated that 115 out of 120 participants attending a Geriatric Day Hospital programme had at least one discrepancy between the medication list from their family physicians and a medication list generated from a comprehensive medication reconciliation that included interviews with the patient and family members and a brown-bag review 10…”

Section: Introductionmentioning

confidence: 99%

Increasing the use of home medication lists in an outpatient neurorehabilitation clinic

et al. 2019

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Medication reconciliation in ambulatory care settings helps prevent adverse drug events. Patient involvement in the process is crucial, as clinicians must verify the reported medication history with other sources such as home medication lists or brown-bagged home medications provided by patients. However, only 47.8% of brain injury and stroke adult outpatients at Toronto Rehabilitation Institute, an academic rehabilitation hospital, bring their medications/medication lists to clinic visits. In turn, missing medication information impacts the clinic by causing delays in treatment and interrupted clinic flow. This project aimed to increase the percentage of patients who bring their medications/medication lists to 80% and decrease the impact on clinic visits caused by missing medication information to 10%. This was a controlled before-after study, with the outpatient rehabilitation assessment (OPRA) clinic as the intervention and the spasticity clinic as the control. The model for improvement was used as the project framework. Process mapping, Ishikawa diagrams, driver diagrams and patient surveys generated the change ideas. Verbal reminders during confirmation phone calls, written reminders and medication list templates were implemented. Data were collected on a biweekly basis and analysed using statistical control charts. After six Plan-Do-Study-Act cycles conducted over 49 weeks, both project aims were achieved. The percentage of OPRA clinic patients who brought medications/medication lists was 81.8% and the impact on clinic visits caused by missing medication information was 9.1% of clinic visits. Special cause variation was detected on the statistical control charts. Conversely, there was no special cause variation for the spasticity clinic (the control) for either aim. Lessons learnt include the importance of prolonged data collection when implementing interventions with long lag time, and that verbal reminders may not be effective for patients with cognitive impairments. Future efforts may focus on implementing the bundle of project interventions for the spasticity clinic.

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Medication documentation in a primary care network serving North Carolina medicaid patients: results of a cross-sectional chart review

Cited by 9 publications

References 25 publications

Safer drug use in primary care - a pilot intervention study to identify improvement needs and make agreements for change in five Swedish primary care units

Safer drug use in primary care - a pilot intervention study to identify improvement needs and make agreements for change in five Swedish primary care units

Information on actual medication use and drug-related problems in older patients: questionnaire or interview?

Increasing the use of home medication lists in an outpatient neurorehabilitation clinic

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