Medication Reconciliation
Conditions
Brief summary
Medication safety is an important concern in hospital Emergency Departments (EDs), which provide approximately 136 million patient visits annually in the US. An accurate list of the patient's medications is often needed to inform medical decision-making. Moreover, health care facilities are required to provide patients with an accurate, reconciled list of their medications upon completion of the visit. However, for 37-87% of patients in the ED, errors are present in the documented medication list, and patients often leave without an updated list of their medications or a good understanding of their self-care instructions. This increases the risk of harmful adverse drug events. Health disparity populations, who are more likely to seek care in EDs and who more often have difficulty providing a complete medication history, are disproportionately affected. Health information technology has the potential to improve medication safety in this setting. PictureRx is an internet-based platform designed to improve medication management in vulnerable populations. It allows users to generate illustrated medication lists in an easily-understood, patient-centered format, in either English or Spanish. The investigators have developed a process for importing prescription fill data from the Surescripts Medication History service, which covers 96% of US pharmacies, into the PictureRx platform. The investigators are developing a mobile tablet PC-based medication history platform that receives and processes the Surescripts data, as well as prompts verification and additional information about the medication regimen. This trial will assess the effect of the PictureRx medication history platform on the accuracy and efficiency of the medication reconciliation process, as well as patient understanding and satisfaction, in hospital Emergency Departments.
Interventions
Tablet PC-based tool to take more complete and accurate medication history
Sponsors
Study design
Eligibility
Inclusion criteria
* Prescribed one or more prescription medications
Exclusion criteria
* Too ill to complete informed consent process
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Changes/Updates in Medication List | 1 day | Participants for whom nurses made updates or corrections to the medication history in electronic health record |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Understanding | 1 week | Assessment of patient understanding of their medication regimen using 4 questions: 1. I understand what medicines I am supposed to take. 2. I understand how much medicine I am supposed to take at a time. 3. I understand what time of day to take each of my medicines. 4. I understand what each of my medicines is for. Participants had the following response options: Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree Due to formatting restrictions on this site and the results being nearly identical for each question, only answers to question 1 are reported below. |
Countries
United States
Participant flow
Pre-assignment details
A total of 250 patients were enrolled into the intervention group. However, only 244 patients could be matched to suitable controls, and 6 were therefore excluded from the analysis of results. Thus the number of patients recruited was 494 (250 intervention + 244 control), but results are presented for 488 (244 intervention + 244 control).
Participants by arm
| Arm | Count |
|---|---|
| PictureRx Participants in the intervention group interacted with the PictureRx medication history platform on a tablet computer to provide information about their medications and verify their list of prescribed medications | 244 |
| Usual Care Patients in the usual care group were matched on a 1:1 basis with intervention patients, on the basis of having received care in the same area of the Emergency Department by the same nurse. Their medication information was collected in the usual fashion by interview. | 244 |
| Total | 488 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Unable to match a control | 6 | 0 |
Baseline characteristics
| Characteristic | PictureRx | Usual Care | Total |
|---|---|---|---|
| Age, Continuous | 41 years STANDARD_DEVIATION 13 | 41 years STANDARD_DEVIATION 16 | 41 years STANDARD_DEVIATION 15 |
| ESI acuity level 2 | 32 Participants | 32 Participants | 64 Participants |
| ESI acuity level 3 | 102 Participants | 102 Participants | 204 Participants |
| ESI acuity level 4 | 96 Participants | 97 Participants | 193 Participants |
| ESI acuity level 5 | 14 Participants | 13 Participants | 27 Participants |
| Race/Ethnicity, Customized American Indian or Alaskan Native | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Asian | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Black or African American | 144 Participants | 151 Participants | 295 Participants |
| Race/Ethnicity, Customized Hispanic | 1 Participants | 13 Participants | 14 Participants |
| Race/Ethnicity, Customized White or Caucasian | 94 Participants | 71 Participants | 165 Participants |
| Region of Enrollment United States | 244 Participants | 244 Participants | 488 Participants |
| Sex: Female, Male Female | 136 Participants | 113 Participants | 249 Participants |
| Sex: Female, Male Male | 108 Participants | 131 Participants | 239 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 244 | 0 / 244 |
| serious Total, serious adverse events | 0 / 244 | 0 / 244 |
Outcome results
Number of Participants With Changes/Updates in Medication List
Participants for whom nurses made updates or corrections to the medication history in electronic health record
Time frame: 1 day
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| PictureRx | Number of Participants With Changes/Updates in Medication List | 101 Participants |
| Usual Care | Number of Participants With Changes/Updates in Medication List | 43 Participants |
Patient Understanding
Assessment of patient understanding of their medication regimen using 4 questions: 1. I understand what medicines I am supposed to take. 2. I understand how much medicine I am supposed to take at a time. 3. I understand what time of day to take each of my medicines. 4. I understand what each of my medicines is for. Participants had the following response options: Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree Due to formatting restrictions on this site and the results being nearly identical for each question, only answers to question 1 are reported below.
Time frame: 1 week
Population: A convenience sample of 50 intervention patients was contacted by phone approximately 1 week after Emergency Department discharge to rate their understanding of their medication regimen.
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| PictureRx | Patient Understanding | Disagree | 0 Participants |
| PictureRx | Patient Understanding | Strongly Disagree | 0 Participants |
| PictureRx | Patient Understanding | Neutral | 1 Participants |
| PictureRx | Patient Understanding | Agree | 3 Participants |
| PictureRx | Patient Understanding | Strongly Agree | 46 Participants |