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Ambulatory Medication Reconciliation and its Impact on Patients with Diabetes

Aug 11, 2018
 

Medication reconciliation reduces emergency room visits in patients with diabetes.

Medication discrepancies arise often and can lead to patient harm. One of the most valuable tools that healthcare professionals can utilize to better patient outcomes is medication reconciliation. Medication reconciliation is a process of comparing a patient’s medication record to what the patient says he or she takes. Many patients have extensive lists of medications that are prescribed from multiple doctors. Because patients with diabetes are at a high risk for medication errors, it has been studied to investigate whether ambulatory medication reconciliation would impact the frequency of emergency department visits.

 

In a retrospective cohort study, patients with diabetes were studied at Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH) from January 1, 2000 through June 30, 2014. Inclusion criteria included patients who were 18 years old or older and had documented evidence of diabetes. These patients were followed for at least one year and received at least one medication reconciliation while they were followed by primary physicians at the hospitals. During a six-month medication reconciliation assessment period, study outcomes were evaluated. For example, medication reconciliation was performed, and outcomes were assessed for six months afterward. A medication was considered reconciled if it was edited on record, a new prescription was written, or if it was confirmed on a special EMR reconciliation screen. The primary outcome was the total number of ED visits between both hospitals during the six-month assessment period. This included hospitalizations for any cause. ED visits for any cause were secondary outcomes.

There were 31,689 patients included in the analysis with 261,765 reconciliation assessment periods. Patients who had all, some, or no diabetic medications reconciled had a mean primary outcome event of 0.354, 0.377, and 0.384 respectively (p<0.0001). Patients who had all, some, or no diabetic medications reconciled had 0.223, 0.232, and 0.230 ED visits (p<0.0296), and 0.132, 0.145, and 0.154 hospitalizations (p<0.0001) respectively. Compared to no medication reconciliation, patients who received medication reconciliations were associated with lower rates of ED visits and hospitalizations. Factors that were associated with more medication reconciliations included feedback to individual providers, greater primary care visits, nonwhite race, high HbA1c levels, and primary language other than English.

Because medication reconciliations cost time for pharmacists and nurses, they are not always completed efficiently or completed at all. However, an effort still needs to be made to reconcile medication  with patients to help prevent ED visits and hospitalizations. In conclusion, medication reconciliations improve patient outcomes and reduce healthcare utilization for preventable events.

Practice Pearls:

  • Medication reconciliation is a good practice to help prevent ED visits and hospitalizations.
  • Patients with diabetes, and all other patients, can benefit from medication reconciliation by providing their physicians with a more accurate medication profile.
  • Medication reconciliations are associated with fewer adverse events, ED visits and hospitalizations.

Reference:

Turchin, Alexander, et al. “Ambulatory Medication Reconciliation and Frequency of Hospitalizations and Emergency Department Visits in Patients with Diabetes.” Diabetes Care, vol. 41, no. 8, Nov. 2018, pp. 1639–1645., doi:10.2337/dc17-1260.

Amanda Cortes LECOM School of Pharmacy PharmD Candidate C/O 2019