Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients

Pai, Amy Barton; Cardone, Katie E.; Manley, Harold J.; Peter, Wendy L. St.; Shaffer, Rachel; Somers, Michael J.; Mehrotra, Rajnish

doi:10.2215/cjn.01420213

Cited by 78 publications

(82 citation statements)

References 32 publications

(35 reference statements)

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“…Unlike other mobile applications, we believe that this is the only mobile application for outpatient use that supports patient-driven medication reconciliation with a feedback loop to correct errors (10,21,22). Communication of medication-related information is particularly crucial for this patient population, because patients frequently experience medication errors as a result of fragmented communication between multiple prescribers (23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Integrating a Smartphone–Based Self–Management System into Usual Care of Advanced CKD

Ong

Jassal

Miller

et al. 2016

CJASN

150

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Background and objectives Patient self-management has been shown to improve health outcomes. We developed a smartphone-based system to boost self-care by patients with CKD and integrated its use into usual CKD care. We determined its acceptability and examined changes in several clinical parameters.Design, setting, participants, & measurements We recruited patients with stage 4 or 5 CKD attending outpatient renal clinics who responded to a general information newsletter about this 6-month proof-of-principle study. The smartphone application targeted four behavioral elements: monitoring BP, medication management, symptom assessment, and tracking laboratory results. Prebuilt customizable algorithms provided real-time personalized patient feedback and alerts to providers when predefined treatment thresholds were crossed or critical changes occurred. Those who died or started RRT within the first 2 months were replaced. Only participants followed for 6 months after recruitment were included in assessing changes in clinical measures. ResultsIn total, 47 patients (26 men; mean age =59 years old; 33% were $65 years old) were enrolled; 60% had never used a smartphone. User adherence was high (.80% performed $80% of recommended assessments) and sustained. The mean reductions in home BP readings between baseline and exit were statistically significant (systolic BP, 23.4 mmHg; 95% confidence interval, 25.0 to 21.8 and diastolic BP, 22.1 mmHg; 95% confidence interval, 22.9 to 21.2); 27% with normal clinic BP readings had newly identified masked hypertension. One hundred twenty-seven medication discrepancies were identified; 59% were medication errors that required an intervention to prevent harm. In exit interviews, patients indicated feeling more confident and in control of their condition; clinicians perceived patients to be better informed and more engaged.Conclusions Integrating a smartphone-based self-management system into usual care of patients with advanced CKD proved feasible and acceptable, and it appeared to be clinically useful. The results provide a strong rationale for a randomized, controlled trial.

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Section: Discussionmentioning

confidence: 99%

Integrating a Smartphone–Based Self–Management System into Usual Care of Advanced CKD

Ong

Jassal

Miller

et al. 2016

CJASN

150

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“…Several studies have shown that dialysis-dependent patients are at an especially elevated risk of medication-related problems, medication discrepancies, and drug-record discrepancies. 3,4,6,7,15,16,[20][21][22][23] In the current 2-year study, the mean number of medication discrepancies identified through ambulatory medication reconciliation was 1.31 per hemodialysis patient and 0.65 per reconciliation process. A previous study reported drug record discrepancies of 1.7 (SD 1.3) per patient when information gathered from the patient was compared with information in an electronic medical record.…”

Section: Discussionmentioning

confidence: 99%

“…17 Providing ambulatory medication reconciliation is critically important to reducing the risk of harm associated with medication discrepancies, such as adverse drug events and admission to hospital. 3 The majority of survey respondents reported that ambulatory medication reconciliation improved the quality of care that practitioners provided to their dialysis patients. As part of our process, a copy of each patient's reconciliation form is sent to the patient and to the relevant community pharmacy and family physician.…”

Section: Discussionmentioning

confidence: 99%

“…Mots clés : bilan comparatif des médicaments, hémodialyse, événements indésirables liés aux médicaments, divergences concernant les médicaments, sondage, sécurité des médicaments INTRODUCTION M edication reconciliation in patients with chronic kidney disease has been shown to improve patient safety by allowing identification and resolution of medication-related problems. [1][2][3][4] It is a structured, shared process whereby health care professionals partner with patients and utilize multiple sources of medication information to obtain a best possible medication history (BPMH), to identify and rectify discrepancies, and to communicate this information to the patient and other relevant health care professionals. 1 The BPMH has been described as a systematic and comprehensive review of all medications that a patient is taking.…”

Section: Résumémentioning

confidence: 99%

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Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

Wilson

Ladda

Tran

et al. 2017

CJHP

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Background: Ambulatory medication reconciliation can reduce the frequency of medication discrepancies and may also reduce adverse drug events. Patients receiving dialysis are at high risk for medication discrepancies because they typically have multiple comorbid conditions, are taking many medications, and are receiving care from many practitioners. Little is known about the potential benefits of ambulatory medication reconciliation for these patients. Objectives: To determine the number, type, and potential level of harm associated with medication discrepancies identified through ambulatory medication reconciliation and to ascertain the views of community pharmacists and family physicians about this service. Methods: This retrospective cohort study involved patients initiating hemodialysis who received ambulatory medication reconciliation in a hospital renal program over the period July 2014 to July 2016. Discrepancies identified on the medication reconciliation forms for study patients were extracted and categorized by discrepancy type and potential level of harm. The level of harm was determined independently by a pharmacist and a nurse practitioner using a defined scoring system. In the event of disagreement, a nephrologist determined the final score. Surveys were sent to 52 community pharmacists and 44 family physicians involved in the care of study patients to collect their opinions and perspectives on ambulatory medication reconciliation. Results: Ambulatory medication reconciliation was conducted 296 times for a total of 147 hemodialysis patients. The mean number of discrepancies identified per patient was 1.31 (standard deviation 2.00). Overall, 30% of these discrepancies were deemed to have the potential to cause moderate to severe patient discomfort or clinical deterioration. Survey results indicated that community practitioners found ambulatory medication reconciliation valuable for providing quality care to dialysis patients. Conclusions: This study has provided evidence that ambulatory medication reconciliation can increase patient safety and potentially prevent adverse events associated with medication discrepancies.

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“…The involvement of pharmacists has been shown to not only identify actual and potential MRPs, but to reduce rehospitalizations and lengths of stay of dialysis patients. 7,8 In another common scenario, the ESRD patient is admitted for an infectious cause or sepsis, receives appropriate intravenous antibiotics after positive wound or blood cultures, and is discharged as soon as clinical symptoms improve, with the presumption that the same antibiotic regimen can be continued in the dialysis unit. Unfortunately, in many cases, the information about the specific intravenous antibiotic is not transmitted to the dialysis facility in time for the facility to order the antibiotics.…”

mentioning

confidence: 99%

Reducing Avoidable Rehospitalization in ESRD

Hakim

Collins

2014

Journal of the American Society of Nephrology

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This program was based on a study of rehospitalization rates by Jencks et al., 2 which highlighted inadequate care coordination by hospitals in Medicare patient hospital discharges, resulting in an approximately 20% readmission rate within 30 days of discharge. The Readmission Reduction Program established a Medicare diagnosis-related group (DRG) payment reduction for hospitals that exceeded the adjusted national average readmission rate for three diagnoses: acute myocardial infarction, congestive heart failure, and pneumonia. For fiscal year 2013, the potential reduction was up to 2% of the following year's total DRG payments, and a further reduction of up to 3% of total DRG payments in fiscal year 2014.Application of the high readmission penalty specifically to the dialysis population has also been proposed, based on the high rate of readmission noted by Jencks et al. 2 and data reported by the US Renal Data System showing an overall rehospitalization rate for patients with ESRD of 34% within 30 days of discharge. 3 This 70% higher rate of hospital readmission brought readmissions of the dialysis population into consideration for a quality metric of the Quality Improvement Program, which can affect up to 2% of the Prospective Payment System for dialysis. 1 The study by Erickson et al. 4 in this issue of JASN highlights the potential relationship between the rate of readmission of dialysis patients and the frequency of face-to-face health care provider (physician and/or advanced practitioner) visits at the dialysis facility in the month after hospital discharge. The mean number of provider-patient interactions among patients who were rehospitalized or died within 30 days of a hospital discharge was 2.161.6 episodes, significantly below the frequency of 3.361.2 episodes among patients who were not rehospitalized and did not die within 30 days of discharge. Among patients who were not rehospitalized, close to 65% were seen $4 times during those 30 days compared with 32.4% of rehospitalized patients. Instrumental variable regression analysis estimated that one additional provider visit (compared with the average of 2.861.5 provider visits per month) may reduce the probability of rehospitalization by an absolute difference of 3.5%, or a relative reduction of 9.7% in the rate of rehospitalization. The authors further highlight the resulting economic health care benefits of an additional provider visit in the 30 days after hospitalization, which they estimate conservatively to be .$240 million in aggregate cost savings to Medicare funds.It is evident that the increased frequency of nephrologist visits to the dialysis unit can be optimized with essential information from the discharging hospital, and timing of the additional visit based on the physician's rounding schedule can be optimized by coordination with the discharge event. However, the association noted by Erickson et al. 4 should be considered in any plan to reduce rehospitalizations in the dialysis population.Maximizing the benefit of increased physician vi...

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Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients

Cited by 78 publications

References 32 publications

Integrating a Smartphone–Based Self–Management System into Usual Care of Advanced CKD

Integrating a Smartphone–Based Self–Management System into Usual Care of Advanced CKD

Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

Reducing Avoidable Rehospitalization in ESRD

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