Stephanie A Gernant1, Alan J Zillich2,3, Margie E Snyder2. 1. 1 University of Connecticut, School of Pharmacy, Storrs, CT, USA. 2. 2 Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN, USA. 3. 3 Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA.
Abstract
BACKGROUND: : Medication therapy management (MTM) may be optimized if pharmacists engaged in health information exchange (HIE) by reviewing unedited medical records. METHODS: : In this nonblinded, randomized, controlled pilot, pharmacists delivered a part of MTM, comprehensive medication reviews (CMRs), to adult patients in a practice-based research network (PBRN). Intervention community pharmacists solicited the last 6 months of patients' primary care provider-held, unedited medical records. The primary and secondary outcomes were the number of medication-related problems (MRPs) and preventive care omissions identified. The intervention was analyzed via Mann-Whitney U test and multivariate linear regression models. Pharmacists were surveyed regarding the available health history's helpfulness in CMR delivery. RESULTS: : Thirty-seven patients received CMRs across the 2 groups. Intervention pharmacists (n = 4) identified significantly more MRPs (median = 11 vs 6; B = 6.98, 95% confidence interval [CI]: 0.005-13.96; P = .049) and omissions in preventive care (24% vs 17%; B = 2.78, 95% CI: 0.46-5.10; P = .009) than usual care pharmacists (n = 3). Intervention pharmacists were more likely to agree they were confident they identified all of the patient's MRPs (47.1% vs 15.8%), but neither group was more likely than the other to believe they had resolved all MRPs (41.2% vs 42.1%). Finally, intervention pharmacists agreed 100% of the time that the available health history helped them complete a better CMR, compared with only 69% of usual care pharmacists. CONCLUSION: : In this pilot, community pharmacists identified more MRPs and omissions in preventive care when they reviewed unedited medical records. Larger studies are warranted to determine whether HIE can improve outcomes.
RCT Entities:
BACKGROUND: : Medication therapy management (MTM) may be optimized if pharmacists engaged in health information exchange (HIE) by reviewing unedited medical records. METHODS: : In this nonblinded, randomized, controlled pilot, pharmacists delivered a part of MTM, comprehensive medication reviews (CMRs), to adult patients in a practice-based research network (PBRN). Intervention community pharmacists solicited the last 6 months of patients' primary care provider-held, unedited medical records. The primary and secondary outcomes were the number of medication-related problems (MRPs) and preventive care omissions identified. The intervention was analyzed via Mann-Whitney U test and multivariate linear regression models. Pharmacists were surveyed regarding the available health history's helpfulness in CMR delivery. RESULTS: : Thirty-seven patients received CMRs across the 2 groups. Intervention pharmacists (n = 4) identified significantly more MRPs (median = 11 vs 6; B = 6.98, 95% confidence interval [CI]: 0.005-13.96; P = .049) and omissions in preventive care (24% vs 17%; B = 2.78, 95% CI: 0.46-5.10; P = .009) than usual care pharmacists (n = 3). Intervention pharmacists were more likely to agree they were confident they identified all of the patient's MRPs (47.1% vs 15.8%), but neither group was more likely than the other to believe they had resolved all MRPs (41.2% vs 42.1%). Finally, intervention pharmacists agreed 100% of the time that the available health history helped them complete a better CMR, compared with only 69% of usual care pharmacists. CONCLUSION: : In this pilot, community pharmacists identified more MRPs and omissions in preventive care when they reviewed unedited medical records. Larger studies are warranted to determine whether HIE can improve outcomes.
Entities:
Keywords:
health information exchange; medication safety; medication therapy management; transitions of care
Authors: Kacie L McPherson; Omolola A Adeoye-Olatunde; Jayna M Osborne; William R Doucette; Stephanie A Gernant; Heather Jaynes; Shobha Phansalkar; Alissa L Russ-Jara; Margie E Snyder Journal: J Am Pharm Assoc (2003) Date: 2020-01-25
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