Transcript Pilot Test Results of Med List - Massachusetts Coalition for the

Medication Safety
Ambulatory Medication Safety
Effie Brickman, Director
Ambulatory Medication Safety
[email protected]
www.macoalition.org
Coalition Practice Pilot Sites
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Solicitation of physicians commenced July 2005
with letters and phone calls to select MA providers
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Cardiologists and Rheumatologists
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Health Centers
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Internists
Obstetrics/Gynecology
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Hospital Professional Organizations
Practice Pilot Sites
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Pilot site agreements reached with:
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Internist (central MA)
Obstetrician/Gynecologist (metro Boston)
Family Practitioner (northeast MA)
Health Center – (central MA)
Interventions
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Patients to carry a medication list to each provider
visit
Promote improved physician-patient interactions,
especially relative to understanding medication
regimen, compliance issues, danger signs/side
effects, potential interactions
Physician to reconcile medications at each visit
Testing Status
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Individual Practitioners
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Between 90% complete with testing medication
list and reconciling process
Health Center
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Initiated testing early January 2006
Withdrew from testing February 2006
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Cited paper process cumbersome with EMR in place
Testing Tool - Patient
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Patient Testing Included:
 Notification to bring medications or list
 Form simple to complete and carry
 Form helpful to keep track of medications,
dosages, reactions, etc.
 Patient understood their medications/purpose
 Process of reviewing medications with
physician helpful
Testing Tool - Physician
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Physician Testing Included:
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Form incorporated all patient specific information
Time available to review medications with patient
Form helpful to keep track of medications, dosages,
reactions, etc.
Inappropriate or conflicting medications found
Medications changed based on reconciling
Errors prevented
Changes recommended for the form and process
Preliminary Feedback- Patients
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Patients didn’t always remember to bring their
medications or list to the visit
Patients thought their physician had a list of all
their medications and already knew the info
Patients thought their physician was already
reconciling medications at each visit
Patients do not know or remember their
discontinued medications
Preliminary Feedback -Patients
(cont’d)
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Patients on fewer medications felt the form was
too big to carry while others felt the form was fine
All patients felt the form included important
information
Most patients felt it was helpful to have their
medications reviewed
Most ob/gyn patients did not know their vaccines
or flu shots
Most ob/gyn patients tested did not think birth
control pills and IUDs are medications
Preliminary Feedback - Physicians
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Physicians felt the form included all
important information
Physicians made updates or additions to
medication list as result of reconciling
Reconciling process affected by patients not
remembering their medications, physician,
pharmacy, and emergency contact info
Preliminary Feedback – Physicians
(cont’d)
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Some inappropriate or conflicting medications
were recorded when comparing the medication list
to the patient record
Physicians did not recommend changing anything
about the time they spent with the patient
reviewing medications
Health Center physicians reported difficulty
reviewing medications with patients requiring an
interpreter (overly time consuming for this patient group)
Preliminary Feedback – Physicians
(cont’d)
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Health Center physicians withdraw from pilot
citing cumbersome process for their setting and
patient population
Physicians had mixed results on whether they
thought the reconciling process was helpful but…
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Updates made to patient’s file based on medication list
review (allergies, meds, etc.)
Additions to medications were made
For older populations, lack of form completion
hindered reconciling process
Timeline
Develop Medication List Prototype
Jul. 2005
Completed
Conduct Search for Pilot Sites
Aug. 2005
Completed
Establish Pilot Site Arrangements and Testing
Agreements
Sep. –
Nov. 2005
Completed
Commence Testing of Medication List with
Physician Practices
Nov.2005 –
Jan. 2006
Completed
Finalize Testing of Medication List with
Physician Practices Obtain Provider and
Consumer User Feedback
Commence Planning for Educational Program
Mar. 2006
Completed
Timeline (cont’d)
Commence work on the Development of a
Strategy and Work Plan to Promote
Implementation of Medication List through
Outreach to Consumers/ Providers
Apr. 2006
Disseminate Medication List/Sheet to
May – June
Physicians and Ambulatory Setting Statewide 2006
Completed
Completed
Next Steps
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Revise Medication List Form and
Reconciling Process Based On Testing
Feedback
Obtain Lessons Learned from Other
Ambulatory Initiatives and Incorporate
Develop Strategy for Statewide
Dissemination of Medication List Form to
Patients and Health Care Providers