2017

Effect of health information exchange on recognition of medication discrepancies is interrupted when data charges are introduced: results of a cluster-randomized controlled trial

Posted on by Ryan J Tran
Study type/ Setting Methods Outcomes Recommendations Source
Cluster randomized

controlled trial

 

Setting: Inpatient

 

 

 - To determine the effect of health information exchange (HIE) on medication prescribing for hospital inpatients

- Patients admitted to an urban hospital received structured medication reconciliation by an intervention pharmacist with access to a regional HIE vs no access to the HIE

- The HIE contained prescribing info from the largest hospitals and pharmacy insurance plan in the region

- Primary endpoint was discrepancies between pre-admission and inpatient medication regimens

 - 186 pts (intervention) vs 195 (control)

- There was no difference between intervention and control in number of discrepancies, discrepancies associated ADEs.

 - HIE may improve outcomes of medication reconciliation, however more efforts are needed to understand and increase prescriber’s rectification of medication discrepancies Boockvar KS et al.

(2017)
Boockvar KS, Ho W, Pruskowski J, et al. Effect of health information exchange on recognition of medication discrepancies is interrupted when data charges are
introduced: results of a cluster-randomized controlled trial. Journal of the American Medical Informatics Association. 2017;24(6):1095-1101. doi:10.1093/jamia/ocx044

 

Assessment of the association between drug disposal practices and drug use and storage behaviors

Posted on by Ryan J Tran
Study type/ Setting Methods Outcomes Recommendations Source
Cross-sectional survey

 

Setting: Multi-sector private

Company

 

 

 The survey assessing participants’ drug handling and storage behaviors was answered by 1,121 employees from across eight provinces of Turkey in 2016. Participants were also significantly less likely to dispose of drugs inappropriately, practice self-medication, be unaware of expired drugs at home, or fail to store drugs according to the labelling Main outcome measures were storage and disposal of unused/unwanted drugs at home in a rational way.

Results: The percentage of participants who declared that they keep unused/unwanted drugs at home was 28.0%. About one-third of participants disposed their unused/unwanted drugs via the ‘‘garbage, sink, toilet, etc.”. Participants 30 years old and living with <4 household members significantly tended to bring their unused/unwanted drugs to the company’s drug-box. Nearly half of all participants (46.5%) stated a recent change in their disposal behavior. The vast majority of participants (94.6%) who previously took drugs back to the company’s drug-box stated that they either had, or would, help their contacts adopt such behaviors.

 Findings showed that while a substantial number of participants still had unused drugs at home or disposed of them inappropriately, it is understood that they started to exhibit more favorable behaviors in recent years. Unused drugs at home might result in an inappropriate medication list during admission. Akici A et al (2017)
Akici A, Aydin V, Kiroglu A. Assessment of the association between drug disposal practices and drug use and storage behaviors. Saudi Pharmaceutical Journal.
2018;26(1):7-13. doi:10.1016/j.jsps.2017.11.006

Initial medication non-adherence: prevalence and predictive factors in a cohort of 1.6 million primary care patients

Posted on by Ryan J Tran
Study type/ Setting Methods Outcomes Recommendations Source
Retrospective, cohort study

 

 

Setting: Primary Care

 

 

 - The aims of this study were to determine prevalence and predictive

factors of initial medication nonadherence (IMNA)- defined as not obtaining a medication the first time it is prescribed in the Catalan health system

(Spain)

- 1.6 million patients with 2.9 million prescriptions were included

 - Total IMNA prevalence was

17.6% of prescriptions - Predictors of IMNA are younger age, American nationality, having pain-related or mental disorder and being treated by a substitute/resident general practitioner in a resident training center.

 - Attempts to strengthen trust in resident general practitioners and improve motivation to initiate a needed medication in the general young and older immigrant population should be addressed in Catalan PC. Aznar-Lou I et al. (2017)
Aznar-Lou I, Fernández A, Gil-Girbau M, et al. Initial medication non-adherence: prevalence and predictive factors in a cohort of 1.6 million primary care patients. British
Journal of Clinical Pharmacology. 2017;83(6):1328-1340. doi:10.1111/bcp.13215

Medicines reconciliation in primary care: a study evaluating the quality of medication-related information provided on discharge from secondary care

Posted on by Ryan J Tran
A collaborative project

 

Setting: Primary Care

 

 

 - The objective was to assess the completeness, timeliness and reconciliation in primary care of medication information on hospital discharge summaries.  - Clinical Commissioning Groups (CCGs) pharmacist identified patients retrospectively from GP prescribing system and collected data that were then entered onto an excel spreadsheet and submitted electronically for collation and analysis - 47 CCGs participated and submitted data for 1,454 patients

- Although many discharge summaries were generated (89%) and transferred (72%) electronically, only 43% were received by the GP practice on the same day (range 0-38 days) - Intentional changes were actioned on the GP system within 7 days of the discharge for 42.5% of patients.  - At least one change was actioned incorrectly for 5.5% of patients.

 - Medication reconciliation in primary care is as important as on admission to hospital

- There is scope to maximize transfer and action on information to improve safety

 Jani Y et al.(2017)

 

No open access version available
Jani Y, Shah C, Hough J. Isqua17-3144Medicines Reconciliation in Primary Care Following Hospitalization. International Journal for Quality in Health Care.
2017;29(suppl_1):39-40. doi:10.1093/intqhc/mzx125.62

The impact of pharmacist-led medication reconciliation during admission at tertiary care hospital. International

Posted on by Ryan J Tran
Study type/ Setting Methods Outcomes Recommendations Source
Prospective 3 month study

 

Setting: Tertiary care hospital

 

 

 - To identify the types of medication discrepancy that occurred during medication reconciliation performed by a pharmacist gathering the best possible medication history

- Medication histories taken by physician and by pharmacist gathering the BPMH were compared

 - Total number of medications recorded by physicians was 2,548, versus 3,085 by the pharmacist.

- 48.3% of patients had at least one unintended medication discrepancy by physicians.

 - Patient medication histories are frequently recorded inaccurately by physicians during admission of patients, resulting in medication-related errors and compromises in patient safety.

- Pharmacists can help in reducing these medication-related errors

 Abdulghani KH et al.

(2017)

 

No open access version available
Abdulghani KH, Aseeri MA, Mahmoud A, Abulezz R. The impact of pharmacist-led medication reconciliation during admission at tertiary care hospital. International
Journal of Clinical Pharmacy. 2017;40(1):196-201. doi:10.1007/s11096-017-0568-6

 

Responsible e-Prescribing Needs e-Discontinuation

Posted on by Ryan J Tran
Study type/ Setting Methods Outcomes Recommendations Source
JAMA network Viewpoint Opinion paper E-prescribing systems that do not allow electronic cancellation of med orders, or e-discontinuation, and can lead to more medication reconciliation errors Fischer S et al. (2017)

No Open Access Version Available
Fischer S, Rose A. Responsible e-Prescribing Needs e-Discontinuation. JAMA. 2017;317(5):469–470. doi:10.1001/jama.2016.19908