| Study type/ Setting | Methods | Outcomes | Recommendations | Source |
| Prospective intervention design
Setting: Outpatient
|
- PharmaCloud is a new technical platform adopted by the National Health Insurance Administration of Taiwan to collect patients’ medical information via cloud technology - The system provides instant access to detailed cloud-based pharmacy claims data from different healthcare facilities for the past 3 months with a lag time of 2 days; it enables healthcare providers to obtain a patient’s medication information via a secured internet portal - Patients were assigned to the PharmaCloud group and the non-PharmaCloud group in the outpatient setting, and then compared their medication usage and expenditure | - After the application of PharmaCloud, the average number of prescribed drug items significantly decreased.
- Intra-hospital medication duplication rates also decreased. |
- The implementation of cloud technology improved patient medication safety while also controlling overall drug expenditure. | Liao C-Y et al. (2019) |
| Liao C-Y, Wu M-F, Poon S-K, et al. Improving medication safety by cloud technology: Progression and value-added applications in Taiwan. International Journal of Medical Informatics. 2019;126:65-71. doi:10.1016/j.ijmedinf.2019.03.012 |
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Medication Reconciliation
Role of pharmacist led home medication review in community setting and the preparation of medication list.
Posted on by Ryan J Tran
| Study type/ Setting | Methods | Outcomes | Recommendations | Source |
| Cross sectional interventional study
Setting: Community
|
- The study was conducted to identify, prevent and resolve potential medication-related problems, optimize pharmacotherapy and
assist in achieving better health outcomes for patients at home through Home Medicines Review (HMR) - HMR is a patient-focused, meticulous and collaborative health care service provided by pharmacists in the community setting. - Study was conducted for a period of 6 months in 85 patients where discrepancies of the prescriptions, knowledge gap of the patients, use of other medication and storage conditions of medicines were evaluated |
- The patient had a lack of knowledge in factors like the name of the drug (34%), the reason for taking the medication (27%), etc.
- Drug interaction was a primary concern main discrepancy found in majority of the prescriptions. - Around 32% of the population experienced ADR on taking the medication and among the patients interviewed, 64% of them didn’t use any OTC drugs along with prescribed drugs. - Around 60 of the interviewed patients stored multiple drugs in a same container and 52 of the patient’s medicines had illegible labels. |
- Qualified pharmacists can play a major role in improving the appropriateness of prescribing, preventing medication related adverse events. | Chandrasekhar D et al. (2019)
|
| Chandrasekhar D, Joseph E, Ghaffoor FA, Thomas HM. Role of pharmacist led home medication review in community setting and the preparation of medication list. Clinical Epidemiology and Global Health. 2019;7(1):66-70. doi:10.1016/j.cegh.2018.01.002 |
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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. |
| 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 |
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In Connecticut: Improving Patient Medication Management in Primary Care
Posted on by Ryan J Tran
| Study type/ Setting | Methods | Outcomes | Recommendations | Source |
| Demonstration project
Setting: Primary Care
|
- 9 pharmacists worked closely with 88 Medicaid patients from July 2009 through May 2010. - The pharmacist was paid to review medical charts and pharmacy claims before meeting with patient, develop patient medication action plans and send summary medication management reports to providers after meeting with patients. | - The pharmacist identified 917 drug therapy problems and resolved nearly 80% of them after 4 encounters.
- The result was an estimated annual saving of $1,123 per patient on medication claims and $472 per patient on medical, hospital, and emergency department expenses. |
Pharmacists can identify and resolve numerous drug therapy problems. Such pharmacist-supported medication management can have a significant impact on clinical and economic outcomes. | Smith M et al. (2011)
|
| Smith M, Giuliano MR, Starkowski MP. In Connecticut: Improving Patient Medication Management in Primary Care. Health Affairs. 2011;30(4):646-654. doi:10.1377/hlthaff.2011.0002 |
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Medication Reconciliation Across Care Transitions in the Pediatric Medical Home.
Posted on by Ryan J Tran
| Study type/ Setting | Methods | Outcomes | Recommendations | Source |
| Retrospective evaluation
Setting: Pediatric primary medical care
|
This was a retrospective evaluation of a medication reconciliation across care transitions (MRAT) program developed and piloted for one year in an academic pediatric primary care medical home. The MRAT involved chart review and contacting caregivers upon receiving external specialist notes or hospital discharge summaries. Data obtained from the program were used to determine the frequency and types of medication discrepancies for children with complex and noncomplex chronic conditions. | MRATs for 124 encounters were evaluated,
74.0% in response to specialist appointments. Chart review revealed a mean of 3.64 discrepancies per patient, and telephone calls revealed 1.39 additional discrepancies per patient. The number of medication discrepancies from both chart review and telephone calls between complex and noncomplex patients was statistically significant, with a mean of 5.63 vs. 3.77 per patient (p = 0.005). Therapy delays occurred in 16.1% of patients due to insurance rejections, family not starting a new medicine, or confusion about the medication change. Mean time required for reconciliation was 24 minutes. In addition to medication reconciliation, 107 interventions completed during MRATs included patient education, adjusting drug therapy, coordinating care between providers, recommending laboratory monitoring, and facilitating patient appointments |
Children are more prone to medication changes during hospitalization. Timely identification of changes improves patient safety. | Condren M
et al 2019
|
| Condren M, Bowling S, Hall B, Woslager M, Shipman A, Mcintosh H. Medication Reconciliation Across Care Transitions in the Pediatric Medical Home. The Joint Commission Journal on Quality and Patient Safety. 2019. doi:10.1016/j.jcjq.2019.01.003 |
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Patient Safety and Quality: An Evidence-Based Handbook for Nurses
Posted on by Ryan J Tran
| Study type/ Setting | Methods | Outcomes | Recommendations | Source |
| Book chapter
Setting: Multiple
|
Discussed medication reconciliation in different care settings | - Ambulatory setting: Miller et al. studies found about 87% of charts had incomplete documentation of medications
- Inpatient: Vira et al. found 38% discrepancy rate for inpatient hospital setting - Transition of care: Pronovost et al. found 94% discrepancy between discharge orders from ICU to transition of care |
Recommendations:
- Identify a standard location where the med history would be reported, an assigned person to document the med history, time frame to resolve the variations, and a standard template to document medication history - Educate provider as well as patient, caregivers - Design and implement monitoring process to evaluate the outcome of the process |
Barnsteiner, J (2008) |
| Hughes R. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008 pp.459-468. | ||||
Medication errors: the importance of an accurate drug history.
Posted on by Ryan J Tran
| Study type/ Setting | Methods | Outcomes | Recommendations | Source |
| Review
|
Emphasized the importance of complete medication history from different sources e.g. physicians, pharmacists and case notes that includes allergy, drug interaction, OTC inclusion, common side effects. | - Cited one study where 59 patients out of 101 patients reported the use of 129 forms of CAMs, but only 36 were documented in the medical record | Recommended some measures that would provide complete medication list
1. Pharmacist-led med history taking 2. Educating newly qualified prescribers on clinical pharmacology, OTC 3. E-prescribing with pre-populated warning messages |
Fitzgerald RJ (2009) |
| Fitzgerald RJ. Medication errors: the importance of an accurate drug history. British Journal of Clinical Pharmacology. 2009;67(6):671-675. doi:10.1111/j.1365- 2125.2009.03424.x |
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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 |
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Technician Medication Reconciliation in Primary Care Is An Overlooked Opportunity
Posted on by Ryan J Tran
| A pilot program; retrospective chart review
Setting: Primary care |
- Boise VA Medical Center - A program aimed to evaluate a pharmacy technician-directed medication reconciliation process in the primary care setting from Feb 2015 - April 2015
- Following completion of the pharmacy techdirected MR pilot, a retrospective chart review was done to identify the number of resolved discrepancies |
- The pharmacy technician had identified 837 discrepancies, 712 of which were considered to be of minor clinical significance and unlikely to affect patient safety and 109
of which were of moderate clinical significance |
- The pharmacy technician–directed MR process helped avoid a number of errors, improved patient care, and ultimately decreased cost to the health care system.
- These experiences highlight the opportunities available to technicians to improve the accuracy and completeness of MR in the primary care setting. |
Bolster and Koyle (2019) |
| Pharmacytimes.com. (2019). Technician Medication Reconciliation in Primary Care Is an Overlooked Opportunity. [online] Available at: https://www.pharmacytimes.com/publications/issue/2019/january2019/technician-medication-reconciliation-in-primary-care-is-an-overlooked-opportunity [Accessed 27 May 2019]. |
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Impact of pharmacists directed medication reconciliation on reducing medication discrepancies during transition of care in hospital setting.
Posted on by Ryan J Tran
| Randomized controlled study
Setting: Hospital
|
- To evaluate the effect of pharmacist's directed services (reconciliation plus counselling) on reducing medication discrepancies during a 3month study period - 200 internal medicine patients from Jordan University Hospital - 2 groups: control vs intervention
- The number and types of medication discrepancies were identified at admission. - At discharge, the number of unintentional discrepancies was evaluated for both groups |
- The total number of identified unintentional discrepancies was 84 for the intervention group compared with 60 discrepancies for the control group.
- At discharge, a significant reduction in the number of unintentional discrepancies was achieved for the intervention group, while no significant change was found for the control group |
- The presence of clinical pharmacists in hospital wards had a promising effect on decreasing the number of medication errors | Salameh
LK et al. (2018)
|
| Salameh LK, Farha RKA, Hammour KMA, Basheti IA. Impact of pharmacists directed medication reconciliation on reducing medication discrepancies during transition of care in hospital setting. Journal of Pharmaceutical Health Services Research. 2018;10(1):149-156. doi:10.1111/jphs.12261 |
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