The Effect of Medication Reconciliation via a Patient Portal on Medication Discrepancies: A Randomized Noninferiority Study

Abstract

Background: Medication reconciliation has become standard care to prevent medication transfer errors. However, this process is time-consuming but could be more efficient when patients are engaged in medication reconciliation via a patient portal. Objectives: To explore whether medication reconciliation by the patient via a patient portal is noninferior to medication reconciliation by a pharmacy technician. Design (including intervention): Open randomized controlled noninferiority trial. Patients were randomized between medication reconciliation via a patient portal (intervention) or medication reconciliation by a pharmacy technician at the preoperative screening (usual care). Setting and Participants: Patients scheduled for elective surgery using at least 1 chronic medication were included. Measures: The primary endpoint was the number of medication discrepancies compared to the electronic nationwide medication record system (NMRS). For the secondary endpoint, time investment of the pharmacy technician for the medication reconciliation interview and patient satisfaction were studied. Noninferiority was analyzed with an independent t test, and the margin was set at 20%. Results: A total of 499 patients were included. The patient portal group contained 241 patients; the usual care group contained 258 patients. The number of medication discrepancies was 2.6 AE 2.5 in the patient portal group and 2.8 AE 2.7 in the usual care group. This was not statistically different and within the predefined noninferiority margin. Patients were satisfied with the use of the patient portal tool. Also, the use of the portal can save on average 6.8 minutes per patient compared with usual care. Conclusions and Implications: Medication reconciliation using a patient portal is noninferior to medication reconciliation by a pharmacy technician with respect to medication discrepancies, and saves time in the medication reconciliation process. Future studies should focus on identifying patient characteristics for successful implementation of patient portal medication reconciliation.

Barriers and facilitators for the usage of a personal health record for medication reconciliation: A qualitative study among patients

“…Not surprisingly, we identified that the overall score of the PHR was higher for PHR users compared to PHR non‐users. Despite the small sample size, our score for the PHR rated by PHR users was comparable (8 versus 8.1) with the mean score of patient satisfaction of using a PHR for MR rated by PHR users ( n = 233) in the study of Ebbens et al 31 This may indicate that our study population is representative of the Dutch population.…”

The Perceived Effectiveness of Secure Messaging for Medication Reconciliation During Transitions of Care: Semistructured Interviews With Patients

“…This may have promoted patients’ overall favorable opinions of SMMRT, despite the barriers experienced when returning SMMRT via secure messaging. Recent literature reports that patients can identify medication discrepancies in their own personal health record with comparable accuracy to a pharmacy technician, supporting the assertion that patients can be closely involved in the medication reconciliation process [ 32 , 33 ], as they were in the SMMRT intervention. SMMRT has the potential to reduce the risk of ADEs and rehospitalizations by providing a mechanism for patients to help identify medication discrepancies.…”

Effectiveness of Medication Reconciliation in a Chinese Hospital: A Pilot Randomized Controlled Trial

“…Performing MR is a time-consuming process. 17 , 18 The patient interview of obtaining the BPMH as the crucial step takes 12 to 46 minutes per patient. 19 , 20 In the electronic medical record system (EMRs), all medical staff can review health records (eg, medication history, laboratory results, simple text reports of microbiology and pathology, or radiographic images) and receive medical assistance from prescription-audit systems, and clinical pharmacists can review lists of medications procured from ambulatory prescription, information stored in local EMRs, and computerized orders.…”