Stephanie W Ong1,2,3,4, Sarbjit V Jassal2,4,5,6,7, Eveline C Porter2,8, Kyoyoon K Min2, Akib Uddin9, Joseph A Cafazzo4,6,9,10, Valeria E Rac4,6,11,12,13,14, George Tomlinson4,5,6,7,13, Alexander G Logan15,5,6,7,16,17. 1. Department of Pharmacy, University Health Network, Toronto, Ontario, Canada. 2. Division of Nephrology, University Health Network, Toronto, Ontario, Canada. 3. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada. 4. Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. 5. Department of Medicine, University Health Network, Toronto, Ontario, Canada. 6. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 7. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 8. Department of Nursing, University Health Network, Toronto, Ontario, Canada. 9. Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, Ontario, Canada. 10. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada. 11. Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto, Ontario, Canada. 12. Program for Health System and Technology Evaluation, Toronto, Ontario, Canada. 13. Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada. 14. Diabetes Action Canada, Canadian Institutes of Health Research Strategy for Patient-Oriented Research Network, Toronto, Ontario, Canada. 15. Division of Nephrology, University Health Network, Toronto, Ontario, Canada logan@lunenfeld.ca. 16. Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada. 17. Department of Medicine, Sinai Health, Toronto, Ontario, Canada.
Abstract
BACKGROUND AND OBJECTIVES: Patients with CKD are at risk for adverse drug reactions, but effective community-based preventive programs remain elusive. In this study, we compared the effectiveness of two digital applications designed to improve outpatient medication safety. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a 1-year randomized controlled trial, 182 outpatients with advanced CKD were randomly assigned to receive a smartphone preloaded with either eKidneyCare (n=89) or MyMedRec (n=93). The experimental intervention, eKidneyCare, includes a medication feature that prompted patients to review medications monthly and report changes, additions, or medication problems to clinicians for reconciliation and early intervention. The active comparator was MyMedRec, a commercially available, standalone application for storing medication and other health information that can be shared with patients' providers. The primary outcome was the rate of medication discrepancy, defined as differences between the patient's reported history and the clinic's medication record, at exit. RESULTS: At exit, the eKidneyCare group had fewer total medication discrepancies compared with MyMedRec (median, 0.45; interquartile range, 0.33-0.63 versus 0.67; interquartile range, 0.40-1.00; P=0.001), and the change from baseline was 0.13±0.27 in eKidneyCare and 0.30±0.41 in MyMedRec (P=0.007). eKidneyCare use also reduced the severity of clinically relevant medication discrepancies in all categories, including those with the potential to cause serious harm (estimated rate ratio, 0.40; 95% confidence interval, 0.27 to 0.63). Usage data revealed that 72% of patients randomized to eKidneyCare completed one or more medication reviews per month, whereas only 30% of patients in the MyMedRec group (adjusted for dropouts) kept their medication profile on their phone. CONCLUSIONS: In patients who are high risk and have CKD, eKidneyCare significantly reduced the rate and severity of medication discrepancies, the proximal cause of medication errors, compared with the active comparator. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: www.ClinicalTrials.gov, NCT:02905474.
BACKGROUND AND OBJECTIVES: Patients with CKD are at risk for adverse drug reactions, but effective community-based preventive programs remain elusive. In this study, we compared the effectiveness of two digital applications designed to improve outpatient medication safety. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a 1-year randomized controlled trial, 182 outpatients with advanced CKD were randomly assigned to receive a smartphone preloaded with either eKidneyCare (n=89) or MyMedRec (n=93). The experimental intervention, eKidneyCare, includes a medication feature that prompted patients to review medications monthly and report changes, additions, or medication problems to clinicians for reconciliation and early intervention. The active comparator was MyMedRec, a commercially available, standalone application for storing medication and other health information that can be shared with patients' providers. The primary outcome was the rate of medication discrepancy, defined as differences between the patient's reported history and the clinic's medication record, at exit. RESULTS: At exit, the eKidneyCare group had fewer total medication discrepancies compared with MyMedRec (median, 0.45; interquartile range, 0.33-0.63 versus 0.67; interquartile range, 0.40-1.00; P=0.001), and the change from baseline was 0.13±0.27 in eKidneyCare and 0.30±0.41 in MyMedRec (P=0.007). eKidneyCare use also reduced the severity of clinically relevant medication discrepancies in all categories, including those with the potential to cause serious harm (estimated rate ratio, 0.40; 95% confidence interval, 0.27 to 0.63). Usage data revealed that 72% of patients randomized to eKidneyCare completed one or more medication reviews per month, whereas only 30% of patients in the MyMedRec group (adjusted for dropouts) kept their medication profile on their phone. CONCLUSIONS: In patients who are high risk and have CKD, eKidneyCare significantly reduced the rate and severity of medication discrepancies, the proximal cause of medication errors, compared with the active comparator. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: www.ClinicalTrials.gov, NCT:02905474.
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