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Sunday, November 1, 2009
Learning Objective 1: discuss factors contributing to medication discrepancies and the impact of medication discrepancies on patient morbidity and mortality.
Learning Objective 2: identify the preliminary findings of an interdisciplinary intervention to resolve medication discrepancies and improve related health outcomes.
Inappropriate medication use and management result in significant morbidity and mortality throughout the world. The transition from hospital to home is an exceptionally risky time for such medication discrepancies because both system errors and patient errors are common. In a completed pilot study, one or more medication discrepancies were identified in 66% of the sample transitioning from hospital to home. In the pilot study, the group receiving the interdisciplinary intervention had significantly greater medication discrepancy resolution as compared to the control group. In addition, there was a trend for reduced urgent and acute care utilization among the intervention group. Unfortunately, the pilot study’s intervention was time and resource intensive. The purpose of the current, ongoing research is to: 1) evaluate the effect of an interdisciplinary nurse-implemented, information-technology intervention to detect and resolve medication discrepancies during patients’ transition from hospital to home care, and 2) evaluate the influence of the intervention on health care use, including physician visits and re-hospitalizations. Guided by the Economic, Clinical, and Humanistic Outcomes (ECHO) Model, a prospective 4-week longitudinal study design is being implemented. Random assignment to group is completed prior to hospital discharge. Adult participants (N=260) who will receive home care services from a large, Medicare-certified, non-profit visiting nurse association in the Pacific Northwestern United States are recruited prior to hospital discharge. Intervention participants receive a nurse-led, information-technology based protocol to detect and resolve medication discrepancies. Both groups receive a visit from a pharmacist (blinded to group assignment) to assess and document medication discrepancies and discrepancy resolution. Reflective of the ECHO Model, outcome measures include medication discrepancy resolution, number of physician visits, and days of re-hospitalization. Preliminary results and practice implications from this randomized clinical trial will be presented.