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Lim A, Abeyaratne C, Reeve E, Desforges K, Malone D. Using Kane's Validity Framework to Compare an Integrated and Single-Skill Objective Structured Clinical Examination. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100756. [PMID: 39002863 DOI: 10.1016/j.ajpe.2024.100756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/11/2024] [Accepted: 07/06/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE The aim of this study was to compare the validity of an integrated objective structured clinical examination (OSCE) station assessing both oral and written components with that of an OSCE station assessing 1 single skill (oral only), both targeted at assessing taking a best possible medication history. METHODS A convergent mixed-methods design that used the 4 inferences of Kane's validity framework (scoring, generalization, extrapolation, and implications) as a scaffold to integrate qualitative data (post-OSCE reflections) and quantitative data (assessment grades and categories of medication errors) was applied. RESULTS In 2022, 216 students completed the OSCE station with the oral component alone, while in 2023, 254 students completed the integrated (oral and written) OSCE station. Students in 2023 performed significantly better, with a median score of 88% vs 80% in 2022. There was a greater proportion of commission errors in the integrated assessment (20.4% vs 15.3%), but fewer omission errors (29.9% vs 31.8%) and patient profile errors (5.1% vs 69.4%). Student reflections revealed that conversations were rushed in the integrated assessment, with a greater focus on written formatting, but an appreciation for the authenticity and structured format of the integrated OSCE compared with the single-skill OSCE alone. CONCLUSION Students completing the integrated OSCE (with oral and written components) had fewer patient profile and medication omission errors than students who completed the oral-only OSCE. Considering Kane's validity framework, there was a stronger argument for the more authentic integrated OSCE in terms of the inferences of extrapolation and implications.
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Affiliation(s)
- Angelina Lim
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Australia; Royal Children's Hospital, Murdoch Children's Research Institute, Parkville, Australia.
| | - Carmen Abeyaratne
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Australia
| | - Emily Reeve
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Australia; University of South Australia, Quality Use of Medicines and Pharmacy Research Centre, Adelaide, Australia; University of South Australia, Clinical and Health Sciences, Adelaide, Australia
| | - Katherine Desforges
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Australia; Université de Montréal, Faculty of Pharmacy, Montréal, Canada
| | - Daniel Malone
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Australia
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Powis M, Dara C, Macedo A, Hack S, Ma L, Mak E, Morley L, Kukreti V, Dave H, Kirkby R, Krzyzanowska MK. Implementation of medication reconciliation in outpatient cancer care. BMJ Open Qual 2023; 12:bmjoq-2022-002211. [PMID: 37247944 DOI: 10.1136/bmjoq-2022-002211] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/07/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Medication reconciliation (MedRec) is a process where providers work with patients to document and communicate comprehensive medication information by creating a complete medication list (best possible medication history (BPMH)) then reconciling it against what patient is actually taking to identify potential issues such as drug-drug interactions. We undertook an environmental scan of current MedRec practices in outpatient cancer care to inform a quality improvement project at our centre with the aim of 30% of patients having a BPMH or MedRec within 30 days of initiating treatment with systemic therapy. METHODS We conducted semi-structured interviews with key stakeholders from 21 cancer centres across Canada, probing on current policies, and barriers and facilitators to MedRec. Guided by the findings of the scan, we then undertook a quality improvement project at our cancer centre, comprising six iterative improvement cycles. RESULTS Most institutions interviewed had a process in place for collecting a BPMH (81%) and targeted patients initiating systemic therapy (59%); however, considerable practice variation was noted and completion of full MedRec was uncommon. Lack of resources, high patient volumes, lack of a common medical record spanning institutions and settings which limits access to medication records from external institutions and community pharmacies were identified as significant barriers. Despite navigating challenges related to the COVID-19 pandemic, we achieved 26.6% of eligible patients with a documented BPMH. However, uptake of full MedRec remained low whereby 4.7% of patients had a documented MedRec. CONCLUSIONS Realising improvements to completion of MedRec in outpatient cancer care is possible but takes considerable time and iteration as the process is complex. Resource allocation and information sharing remain major barriers which need to be addressed in order to observe meaningful improvements in MedRec.
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Affiliation(s)
- Melanie Powis
- Cancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Celina Dara
- Cancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Pharmacy, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Alyssa Macedo
- Cancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Saidah Hack
- Cancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Lucy Ma
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ernie Mak
- Cancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lyndon Morley
- Department of Radiation Medicine, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Vishal Kukreti
- Cancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Hemangi Dave
- Pharmacy, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Ryan Kirkby
- Cancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Cancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Gonzales HM, Fleming JN, Gebregziabher M, Posadas Salas MA, McGillicuddy JW, Taber DJ. A Critical Analysis of the Specific Pharmacist Interventions and Risk Assessments During the 12-Month TRANSAFE Rx Randomized Controlled Trial. Ann Pharmacother 2021; 56:685-690. [PMID: 34496669 DOI: 10.1177/10600280211044792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Medication safety issues have detrimental implications on long-term outcomes in the high-risk kidney transplant (KTX) population. Medication errors, adverse drug events, and medication nonadherence are important and modifiable mechanisms of graft loss. OBJECTIVE To describe the frequency and types of interventions made during a pharmacist-led, mobile health-based intervention in KTX recipients and the impact on patient risk levels. METHODS This was a secondary analysis of data collected during a 12-month, parallel-arm, 1:1 randomized clinical controlled trial including 136 KTX recipients. Participants were randomized to receive either usual care or supplemental, pharmacist-driven medication therapy monitoring and management using a smartphone-enabled app integrated with telemonitoring of blood pressure and glucose (when applicable) and risk-based televisits. The primary outcome was pharmacist intervention type. Secondary outcomes included frequency of interventions and changes in risk levels. RESULTS A total of 68 patients were randomized to the intervention and included in this analysis. The mean age at baseline was 50.2 years; 51.5% of participants were male, and 58.8% were black. Primary pharmacist intervention types were medication reconciliation and patient education, followed by medication changes. Medication reconciliation remained high throughout the study period, whereas education and medication changes trended downward. From baseline to month 12, we observed an approximately 15% decrease in high-risk patients and a corresponding 15% increase in medium- or low-risk patients. CONCLUSION AND RELEVANCE A pharmacist-led mHealth intervention may enhance opportunities for pharmacological and nonpharmacological interventions and mitigate risk levels in KTX recipients.
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Affiliation(s)
| | | | | | | | | | - David J Taber
- Medical University of South Carolina, Charleston, SC, USA
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Abolhassani N, Vollenweider P, Waeber G, Marques-Vidal P. Ten-Year Trend in Polypharmacy in the Lausanne Population. J Patient Saf 2021; 17:e269-e273. [PMID: 32168266 DOI: 10.1097/pts.0000000000000651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aging and associated morbidities place individuals at higher risk of polypharmacy and drug-drug interactions (DDIs). How polypharmacy and DDIs change with aging is important for public health management. OBJECTIVES The aim of the study was to assess the 10-year trends in prevalence of polypharmacy and potential DDIs in a population-based sample. METHODS Baseline (2003-2006) and follow-up (2014-2016) data were obtained from a sample of 4512 participants (baseline age range = 35-75 y, 55.1% women) from the population of Lausanne, Switzerland. Polypharmacy and polyactive drug use were defined by the regular use of five or more medications and five or more pharmacologically active substances, respectively. Drug-drug interactions were defined according to the criteria of the Geneva University Hospital. RESULTS The percentage of participants taking at least one drug increased from 56.1% to 79.5% (P < 0.001). Among participants taking drugs, number of medications increased from 2.6 ± 1.9 (mean ± standard deviation) to 3.8 ± 2.9 after 10.9-year follow-up (P < 0.001); the corresponding values for active substances were 2.7 ± 2.0 and 4.0 ± 3.0 (P < 0.001). The prevalence of polypharmacy and polyactive substance use increased from 7.7% to 25.0% and from 8.8% to 27.1%, respectively (P < 0.001). The presence of at least one potential DDI increased from less than 1% to almost one sixth of all participants. CONCLUSIONS In a community-dwelling sample, the prevalence of polypharmacy and polyactive substance use tripled during a 10.9-year follow-up, with an even greater increase in the prevalence of potential DDIs. Increasing rates of polypharmacy and DDIS warns the importance of preventing potential DDIs throughout healthcare system through various interventions.
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Affiliation(s)
- Nazanin Abolhassani
- From the Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Pharmacist-Led Collaborative Medication Management for the Elderly with Chronic Kidney Disease and Polypharmacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084370. [PMID: 33924094 PMCID: PMC8074256 DOI: 10.3390/ijerph18084370] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022]
Abstract
Inappropriate polypharmacy is likely in older adults with chronic kidney disease (CKD) owing to the considerable burden of comorbidities. We aimed to describe the impact of pharmacist-led geriatric medication management service (MMS) on the quality of medication use. This retrospective descriptive study included 95 patients who received geriatric MMS in an ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The average age of the patients was 74.9 ± 7.3 years; 40% of them had CKD Stage 4 or 5. Medication use quality was assessed in 87 patients. After providing MMS, the total number of medications and potentially inappropriate medications (PIMs) decreased from 13.5 ± 4.3 to 10.9 ± 3.8 and 1.6 ± 1.4 to 1.0 ± 1.2 (both p < 0.001), respectively. Furthermore, the number of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, “missing patient documentation” was the most common, followed by “adverse effect” and “drug not indicated.” The most frequent intervention was “therapy stopped”. In conclusion, polypharmacy and PIMs were prevalent in older adults with CKD; pharmacist-led geriatric MMS improved the quality of medication use in this population.
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Famiyeh IM, Jobanputra N, McCarthy LM. Best Possible Medication Histories by Registered Pharmacy Technicians in Ambulatory Care. Can J Hosp Pharm 2021; 74:149-155. [PMID: 33896955 PMCID: PMC8042196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Ida-Maisie Famiyeh
- , RPh, BScPhm, ACPR, MSc, is with Women's College Hospital, Toronto, Ontario
| | - Neil Jobanputra
- , RPh, MPharm, HBSc, was, at the time of this study, with Women's College Hospital, Toronto, Ontario. He is now with HealthPRO Procurement Services Inc, Toronto, Ontario
| | - Lisa M McCarthy
- , RPh, BScPhm, PharmD, MSc, was, at the time of this study, with Women's College Hospital, Toronto, Ontario; she is now with the Institute for Better Health and the Pharmacy Department at Trillium Health Partners, Mississauga, Ontario. She maintains her affiliation with the Leslie Dan Faculty of Pharmacy and the Department of Family and Community Medicine, University of Toronto, Toronto, Ontario
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Cohen EA, McKimmy D, Cerilli A, Kulkarni S. A Pharmacist-Driven Intervention Designed to Improve Medication Accuracy in the Outpatient Kidney Transplant Setting. DRUG HEALTHCARE AND PATIENT SAFETY 2020; 12:229-235. [PMID: 33269008 PMCID: PMC7701366 DOI: 10.2147/dhps.s264022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/31/2020] [Indexed: 11/23/2022]
Abstract
Background Medication errors are one of the leading causes of complications and readmissions in healthcare and stem directly from inadequate medication lists. In transplantation, medication discrepancies can lead to fluctuating levels of immunosuppression, resulting in rejection, infection, or drug toxicity. Methods We implemented a pharmacist-driven intervention designed to improve the accuracy of outpatient kidney transplant patients’ medication lists in the electronic medical record (EMR). Baseline medication error rates (Phase 1) were collected, and the intervention was a dedicated pharmacist (Phase 2) who performed medication reconciliation with patients. The primary outcome was the percent of patients with inadequate medication reconciliation determined by any one error in medication reconciliation (Phase 1 vs Phase 2). Secondary outcomes included the number of medication errors, of all medications and high-risk medications, identified per patient sample using statistical process control phase analysis. Results Pharmacist-driven medication reconciliation significantly reduced medication list discrepancies from 95% to 28% (P<0.05). There were a total of 398 errors in the control group and 49 errors in the intervention group. In addition, there were 73 high-risk medication discrepancies in the control group and three in the intervention group. The total number of medication errors decreased post-intervention with a marked reduction in the variation of control limits (LCL, UCL: phase 1, −34.3, 113.9; phase 2, −7.1, 15.3) and average number of medication errors per sample (phase 1, 39.8; phase 2, 14.1). For high-risk medications, phase analysis demonstrated a marked reduction in control limit variation between phases (LCL, UCL: phase 1, −10.4, 25.0; phase 2, −0.5, 0.7) and average number of medication errors per sample (phase 1, 7.3; phase 2, 0.1). Discussion A dedicated pharmacist improved medication list accuracy over conventional practice that utilizes transplant nurses and physicians. Further studies into the cost-effectiveness of this strategy should further justify this approach.
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Affiliation(s)
- Elizabeth A Cohen
- Yale New Haven Transplant Center, Yale New Haven Hospital, New Haven, CT, USA
| | - Danielle McKimmy
- Department of Pharmacy, University of Florida Health Shands Hospital, Gainsville, FL, USA
| | - Anna Cerilli
- Heart and Vascular Center, Yale-New Haven Hospital, New Haven, CT, USA
| | - Sanjay Kulkarni
- Section of Organ Transplantation, Yale University School of Medicine, New Haven, CT, USA
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Harper PG, Schafer KM, Van Riper K, Justesen K, Ramer T, Wicks C, Oyenuga A, Budd J. Team-based approach to improving medication reconciliation rates in family medicine residency clinics. J Am Pharm Assoc (2003) 2020; 61:e46-e52. [PMID: 32919924 DOI: 10.1016/j.japh.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this quality improvement project was to design and implement a systematic team-based care approach to medication reconciliation, with a goal of physician-documented medication reconciliation at 70% of all patient office visits. SETTING Ambulatory clinics located in urban, underserved communities in Minneapolis and St. Paul, MN. PRACTICE DESCRIPTION Four family medicine residency clinics, with pharmacists integrated at each site. All clinics use the Epic electronic medical record (Epic Systems Corporation). PRACTICE INNOVATION A team-based care approach to medication reconciliation was designed and implemented involving medical assistants (MAs), physicians, and pharmacists. The MAs did an initial review with patients, the physicians addressed discrepancies, and difficult situations were escalated to the pharmacist for a detailed assessment. EVALUATION The percentage of visits with physician-documented medication reconciliation was measured preintervention and then for 18 months postintervention in 6-month intervals involving more than 118,000 patient visits. Satisfaction surveys of team members were done pre- and postintervention. RESULTS The percentage of visits with physician-documented medication reconciliation improved significantly from 6.5% preintervention to 58.7% (P < 0.001) postintervention, and was sustained and further improved to 70.3% (P < 0.001) 1 year later. The team members had a statistically significant improvement in their ability to articulate the medication reconciliation process. Satisfaction improved significantly for physicians, but MAs did not experience a statistically significant change. CONCLUSION A team-based care approach to medication reconciliation was successfully implemented and sustained at 4 family medicine clinics. There was significant improvement in physician-documented medication reconciliation. Future studies need to address whether this process improves medication-list discrepancies, completeness, and accuracy.
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Fernandes BD, Almeida PHRF, Foppa AA, Sousa CT, Ayres LR, Chemello C. Pharmacist-led medication reconciliation at patient discharge: A scoping review. Res Social Adm Pharm 2020; 16:605-613. [DOI: 10.1016/j.sapharm.2019.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 11/28/2022]
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Mixon AS, Kripalani S. The Challenges of Medication Reconciliation for the Medical Home. Jt Comm J Qual Patient Saf 2019; 45:531-533. [PMID: 31235407 DOI: 10.1016/j.jcjq.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Phan H, Williams M, McElroy K, Burton B, Fu D, Khandoobhai A. Implementation of a student pharmacist-driven medication history service for ambulatory oncology patients in a large academic medical center. J Oncol Pharm Pract 2019; 25:1419-1424. [PMID: 30808276 DOI: 10.1177/1078155219831066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patients who have an up-to-date and accurate medication list are less susceptible to medication errors and allow care teams to make more informed treatment decisions. Through utilizing student pharmacists to provide medication history services, we anticipate improved patient safety and overall quality of patient care. The purpose of this project was to implement a medication history service for ambulatory oncology patients of the Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Hospital. METHODS A phased approach was utilized to implement a standardized operating procedure for completing medication histories in ambulatory oncology patients. Data collection included number of total medication discrepancies, percentage of patients with high-risk medications, and high-risk medication classes involved in discrepancies. Additionally, time data were collected, including time spent calling the patient, completing patient work up, and preceptor oversight. RESULTS Students completed medication histories for 60 patients; 83% of patients had at least one discrepancy with 21% of those discrepancies involving a high-risk medication. High-risk medications involved in discrepancies included oral chemotherapeutic agents, anticoagulants, insulin, and opioids. CONCLUSION The majority of patients seen had at least one medication discrepancy that was identified and corrected through the medication history service. By correcting the discrepancy, the likelihood of medication errors occurring was decreased. Continuous workflow changes are being made to identify the number and type of resources to expand the service to all appropriate ambulatory oncology patients at the Sidney Kimmel Comprehensive Cancer Center.
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Affiliation(s)
- Ha Phan
- 1 Johns Hopkins Home Care Group, Pharmacy Services, Baltimore, Maryland
| | - Macey Williams
- 2 Beaumont Hospital Grosse Pointe, Department of Pharmacy, Grosse, Michigan
| | - Kelly McElroy
- 3 The Johns Hopkins Hospital, Department of Pharmacy, Division of Oncology, Baltimore, Maryland
| | - Bradley Burton
- 3 The Johns Hopkins Hospital, Department of Pharmacy, Division of Oncology, Baltimore, Maryland
| | - Denise Fu
- 1 Johns Hopkins Home Care Group, Pharmacy Services, Baltimore, Maryland
| | - Anand Khandoobhai
- 3 The Johns Hopkins Hospital, Department of Pharmacy, Division of Oncology, Baltimore, Maryland
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Choi SJ, Storey R, Parikh SV, Bostwick JR. The Impact of Completing Medication Reconciliation and Depression Treatment History in an Outpatient Depression Clinic. PSYCHOPHARMACOLOGY BULLETIN 2019; 49:44-55. [PMID: 30858638 PMCID: PMC6386433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To enhance depression care by improving medication information available prior to initial patient consultations. EXPERIMENTAL DESIGN AND SAMPLE Single-center, with intervention delivered to all new patient referrals at a tertiary care depression clinic. Trained pharmacy students utilizing a standard script prior to the first consultation visit conducted a medication review and depression treatment telephone assessment. RESULTS From 225 individuals contacted once by phone in the week prior to scheduled initial consultation, 141 (62.7%) were reached and 113 (50.2%) completed the full phone assessment. An average of 4-5 medication discrepancies were identified per respondent, of which one-third were considered potentially clinically significant and more than 96% of patients having at least one reported discrepancy. Individuals who completed the call were also more likely to attend the initial consultation. In the medical record, 55 of the 106 (51.9%) pharmacy notes were incorporated in the clinical assessment note. On survey, clinicians reported that access to the pharmacy note saved clinician time, with all prescribing clinicians indicating the pharmacy note significantly influenced subsequent medication recommendations. CONCLUSIONS Telephone assessments conducted by pharmacy students prior to an initial depression clinic consultation was associated with higher consultation attendance, identified a large number of medication discrepancies, were successfully reviewed and received by clinicians, potentially saved clinician time, and influenced subsequent medication prescribing.
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Affiliation(s)
- Sarah J Choi
- Choi and Storey, PharmD Candidates of 2020, University of Michigan. Parikh, MD, John F. Greden Professor of Depression and Clinical Neuroscience, Professor of Psychiatry, Professor of Health Management and Policy - School of Public Health, Associate Director, University of Michigan Comprehensive Depression Center; Bostwick, PharmD, BCPS, BCPP, Clinical Associate Professor and Associate Chair, Department of Clinical Pharmacy, and Clinical Pharmacist in Psychiatry, Michigan Medicine, University of Michigan
| | - Roberta Storey
- Choi and Storey, PharmD Candidates of 2020, University of Michigan. Parikh, MD, John F. Greden Professor of Depression and Clinical Neuroscience, Professor of Psychiatry, Professor of Health Management and Policy - School of Public Health, Associate Director, University of Michigan Comprehensive Depression Center; Bostwick, PharmD, BCPS, BCPP, Clinical Associate Professor and Associate Chair, Department of Clinical Pharmacy, and Clinical Pharmacist in Psychiatry, Michigan Medicine, University of Michigan
| | - Sagar V Parikh
- Choi and Storey, PharmD Candidates of 2020, University of Michigan. Parikh, MD, John F. Greden Professor of Depression and Clinical Neuroscience, Professor of Psychiatry, Professor of Health Management and Policy - School of Public Health, Associate Director, University of Michigan Comprehensive Depression Center; Bostwick, PharmD, BCPS, BCPP, Clinical Associate Professor and Associate Chair, Department of Clinical Pharmacy, and Clinical Pharmacist in Psychiatry, Michigan Medicine, University of Michigan
| | - Jolene R Bostwick
- Choi and Storey, PharmD Candidates of 2020, University of Michigan. Parikh, MD, John F. Greden Professor of Depression and Clinical Neuroscience, Professor of Psychiatry, Professor of Health Management and Policy - School of Public Health, Associate Director, University of Michigan Comprehensive Depression Center; Bostwick, PharmD, BCPS, BCPP, Clinical Associate Professor and Associate Chair, Department of Clinical Pharmacy, and Clinical Pharmacist in Psychiatry, Michigan Medicine, University of Michigan
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Lesselroth BJ, Adams K, Church VL, Tallett S, Russ Y, Wiedrick J, Forsberg C, Dorr DA. Evaluation of Multimedia Medication Reconciliation Software: A Randomized Controlled, Single-Blind Trial to Measure Diagnostic Accuracy for Discrepancy Detection. Appl Clin Inform 2018; 9:285-301. [PMID: 29719884 DOI: 10.1055/s-0038-1645889] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Veterans Affairs Portland Healthcare System developed a medication history collection software that displays prescription names and medication images. OBJECTIVE This article measures the frequency of medication discrepancy reporting using the medication history collection software and compares with the frequency of reporting using a paper-based process. This article also determines the accuracy of each method by comparing both strategies to a best possible medication history. STUDY DESIGN Randomized, controlled, single-blind trial. SETTING Three community-based primary care clinics associated with the Veterans Affairs Portland Healthcare System: a 300-bed teaching facility and ambulatory care network serving Veteran soldiers in the Pacific Northwest United States. PARTICIPANTS Of 212 patients with primary care appointments, 209 patients fulfilled the study requirements. INTERVENTION Patients randomized to a software-directed medication history or a paper-based medication history. Randomization and allocation to treatment groups were performed using a computer-based random number generator. Assignments were placed in a sealed envelope and opened after participant consent. The research coordinator did not know or have access to the treatment assignment until the time of presentation. MAIN OUTCOME MEASURES The primary analysis compared the discrepancy detection rates between groups with respect to the health record and a best possible medication history. RESULTS Of 3,500 medications reviewed, we detected 1,435 discrepancies. Forty-six percent of those discrepancies were potentially high risk for causing an adverse drug event. There was no difference in detection rates between treatment arms. Software sensitivity was 83% and specificity was 91%; paper sensitivity was 81% and specificity was 94%. No participants were lost to follow-up. CONCLUSION The medication history collection software is an efficient and scalable method for gathering a medication history and detecting high-risk discrepancies. Although it included medication images, the technology did not improve accuracy over a paper list when compared with a best possible medication history. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02135731.
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Affiliation(s)
- Blake J Lesselroth
- NorthWest Innovation Center, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Kathleen Adams
- NorthWest Innovation Center, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - Victoria L Church
- NorthWest Innovation Center, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - Stephanie Tallett
- NorthWest Innovation Center, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - Yelizaveta Russ
- Division of Primary Care, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - Jack Wiedrick
- Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, Oregon, United States
| | - Christopher Forsberg
- Center of Innovation, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
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14
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Ottney A, Koski R. Addressing meaningful use and maintaining an accurate medication list in primary care. J Am Pharm Assoc (2003) 2018; 58:186-190. [PMID: 29397343 DOI: 10.1016/j.japh.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/02/2018] [Accepted: 01/02/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The primary objective of this project was to determine the difference in medication list accuracy between an initial and follow-up medication reconciliation visit in a primary care office. Secondary objectives were to identify the difference in medication-related problems most commonly encountered during the visits, factors that may influence patient understanding of their medication regimen, and physician perceptions of the medication review visit. SETTING Quasi-experimental study part of a larger pilot project to address the ability of how health information technology can be used to maintain an active medication list. PRACTICE DESCRIPTION Three family medicine residency clinics in the Midwest. Adult patients with diabetes or chronic obstructive pulmonary disease who had 6 or more long-term medications listed in the electronic health record (EHR) were recruited to participate. PRACTICE INNOVATION An initial comprehensive medication reconciliation visit was conducted by a resident physician and a pharmacist with the goal of ensuring an accurate, easy-to-follow, electronically developed medication list. A follow-up visit with the pharmacist occurred 3-6 months after the initial visit. EVALUATION Medication list accuracy and medication-related problems were assessed at the initial and follow-up visits. Patient-related factors that could affect medication understanding were collected at the initial visit with status of enrollment in the EHR patient portal. RESULTS Fifty-seven of 65 patients completed the study. The number of patients with an accurate medication list increased from 40% to 49% (P = 0.38). The number of medication-related problems decreased from 146 to 91 (P < 0.001). The use of special tools (e.g., pillboxes) was associated with fewer medication regimen errors (P = 0.036). Patients enrolled in the EHR patient portal were more likely to know the purpose of their medications as compared with those not enrolled (P = 0.019). CONCLUSION An intentionally scheduled medication review with a primary care provider and pharmacist did not significantly improve the accuracy of the medication list, but it was associated with fewer drug-related problems.
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Schnipper JL, Labonville S. Medication reconciliation in ambulatory care: A work in progress. Am J Health Syst Pharm 2018; 73:1813-1814. [PMID: 27821394 DOI: 10.2146/ajhp160672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jeffrey L Schnipper
- Division of General Internal Medicine and Primary CareBrigham and Women's HospitalBoston,
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16
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Albano ME, Bostwick JR, Ward KM, Fluent T, Choe HM. Discrepancies Identified Through a Telephone-Based, Student-Led Initiative for Medication Reconciliation in Ambulatory Psychiatry. J Pharm Pract 2017. [PMID: 28629301 DOI: 10.1177/0897190017715391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify the number of medication discrepancies following establishment of a telephone-based, introductory pharmacy practice experience student-driven, medication reconciliation service for new patients in an ambulatory psychiatry clinic. Secondarily, to identify factors impacting medication discrepancies to better target medication profiles to reconcile and to evaluate whether the implementation of a call schedule effected clinic no-show rates. METHODS This was a retrospective analysis of a telephone-based medication reconciliation service from June 2014 to January 2016. RESULTS At least 1 medication discrepancy was identified among 84.7% of medication profiles (N = 438), with a total of 1416 medication discrepancies reconciled (3.2 discrepancies per patient). Of the 1416 discrepancies, 38.6% were deletions, 38.9% were additions, and 22.5% were changes in dosage strength or frequency. Discrepancies pertaining to prescription medications totaled 57.8%. Student pharmacists were critical team members in the service. Patient's age, number of medications on the patient's list, and number of days since the last medication reconciliation were not clinically significant determinants for targeting medication profiles. There was a statistically significant reduction in the clinic no-show rates following implementation of a call schedule compared with no-show rates prior to call schedule implementation. CONCLUSION This student pharmacist-led telephone medication reconciliation service demonstrated the importance of medication reconciliation in ambulatory psychiatry by identifying numerous discrepancies within this population. Further, we demonstrated pharmacy students across various levels of education can assist in this process under the supervision of a pharmacist.
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Affiliation(s)
- Marie E Albano
- 1 University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | | | - Kristen M Ward
- 1 University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Thomas Fluent
- 2 Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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Kavanagh C. Medication governance: preventing errors and promoting patient safety. BRITISH JOURNAL OF NURSING 2017; 26:159-165. [PMID: 28185490 DOI: 10.12968/bjon.2017.26.3.159] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Caroline Kavanagh
- Lecturer, Department of Nursing, Health Sciences and Social Care, Galway-Mayo Institute of Technology, Mayo Campus, Castlebar, County Mayo, Ireland
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