Evaluation of a web-based medication reconciliation application within a primary care setting: Results from a cluster randomized controlled trial

Patient Perspectives on a Digital Assistant for Medication Reconciliation: An Interview Study Comparing Socioeconomic Groups

Medication reconciliation, the process of documenting a patient's medication, is currently a time-consuming and labor-intensive process. To make medication reconciliation more efficient, digital assistants (DAs) offer a promising solution. Especially since human-like digital interfaces tend to be appreciated by more vulnerable populations such as patients in a low socioeconomic position (SEP). Despite the potential of DAs for low-SEP populations in particular, these groups are often not involved during the development and design phase of such digital health interventions. This exclusion may explain the lower adoption rates of digital interventions among low-SEP patients and exacerbate the so-called digital divide. We explored the perceptions and needs of patients across the SEP gradient using a participatory design approach. Patients of low-, middle-, and high-SEP backgrounds were asked to interact with a DA developed for this study and were interviewed afterward. A thematic analysis revealed seven themes regarding design, input method, comprehensibility, privacy concerns, benefits, the intention to use, and reassurance. Overall, patients were afraid to make mistakes in their medication entries and therefore valued feedback from the system or caregivers. Low-SEP patients specifically seemed to value more structured input methods when using the DA, while high-SEP patients emphasized the importance of a secure environment for the DA and sought clarity about its functionalities. Our study demonstrates the importance of involving patients across the socioeconomic gradient when developing a digital health tool and offers concrete recommendations for inclusive DA design for researchers and developers.

Electronic Medication Reconciliation Tools Aimed at Healthcare Professionals to Support Medication Reconciliation: a Systematic Review

The development of health information technology available and accessible to professionals is increasing in the last few years. However, a low number of electronic health tools included some kind of information about medication reconciliation. To identify all the electronic medication reconciliation tools aimed at healthcare professionals and summarize their main features, availability, and clinical impact on patient safety. A systematic review of studies that included a description of an electronic medication reconciliation tool (web-based or mobile app) aimed at healthcare professionals was conducted. The review protocol was registered with PROSPERO: registration number CRD42022366662, and followed PRISMA guidelines. The literature search was performed using four healthcare databases: PubMed, EMBASE, Cochrane Library, and Scopus with no language or publication date restrictions. We identified a total of 1227 articles, of which only 12 met the inclusion criteria.Through these articles,12 electronic tools were detected. Viewing and comparing different medication lists and grouping medications into multiple categories were some of the more recurring features of the tools. With respect to the clinical impact on patient safety, a reduction in adverse drug events or medication discrepancies was detected in up to four tools, but no significant differences in emergency room visits or hospital readmissions were found. 12 e-MedRec tools aimed at health professionals have been developed to date but none was designed as a mobile app. The main features that healthcare professionals requested to be included in e-MedRec tools were interoperability, "user-friendly" information, and integration with the ordering process.

Barriers and Facilitators of Communication in the Medication Reconciliation Process during Hospital Discharge: Primary Healthcare Professionals' Perspectives

The WHO established that medication errors are the most common and preventable errors and represent an expenditure of 42 billion U.S. dollars annually. The risk of medication errors increases in transitions between levels of care, mainly from hospital care to primary healthcare after hospital discharge. In this context, communication is a key element in the safety of the medication reconciliation process. The aim of this paper was to describe the barriers to, and facilitators of, effective communication during the medication reconciliation process at hospital discharge in people over 65 years of age, from the perspective of primary healthcare professionals. A qualitative descriptive study was designed, and in-depth interviews were conducted with 21 individuals, of whom 13 were nurses and 8 were physicians. This study was carried out with healthcare professionals belonging to primary healthcare centres in Huelva (Spain). Following content analysis of the discourses we identified 19 categories, grouped into three areas: interlevel communication, communication between primary healthcare professionals, and communication between healthcare professionals and patients/caregivers. The barriers found mainly relate to the adequacy and use of technological tools, time available, workload and the level of collaboration of patients/caregivers. Facilitating elements for communication in medication reconciliation included technologies, such as computerized medical history, protocolization of clinical sessions, the presence of case management nurse and interdisciplinary teamwork.