Condren Michelle, Bowling Shea, Hall Brian, Woslager Megan, Shipman Amber, McIntosh Heather
Jt Comm J Qual Patient Saf. 2019 Aug;45(8):536-542. doi: 10.1016/j.jcjq.2019.01.003. Epub 2019 Mar 19.
To characterize medication discrepancies for patients with chronic illnesses seen at outside facilities.
This was a retrospective evaluation of a medication reconciliation across care transitions (MRAT) program developed and piloted for one year in an academic pediatric primary care medical home. The MRAT involved chart review and contacting caregivers upon receiving external specialist notes or hospital discharge summaries. Data obtained from the program were used to determine the frequency and types of medication discrepancies for children with complex and noncomplex chronic conditions.
MRATs for 124 encounters were evaluated, 74.0% in response to specialist appointments. Chart review revealed a mean of 3.64 discrepancies per patient, and telephone calls revealed 1.39 additional discrepancies per patient. The number of medication discrepancies from both chart review and telephone calls between complex and noncomplex patients was statistically significant, with a mean of 5.63 vs. 3.77 per patient (p = 0.005). Therapy delays occurred in 16.1% of patients due to insurance rejections, family not starting a new medicine, or confusion about the medication change. Mean time required for reconciliation was 24 minutes. In addition to medication reconciliation, 107 interventions completed during MRATs included patient education, adjusting drug therapy, coordinating care between providers, recommending laboratory monitoring, and facilitating patient appointments.
Children with chronic illness often experience medication changes and delays in therapy when seen in the hospital or by specialists. Timely identification of these changes improves communication and offers the opportunity to identify and prevent problems with medication therapy.
描述在外部医疗机构就诊的慢性病患者的用药差异。
这是一项对在一家学术性儿科初级保健医疗之家开发并试点一年的跨医疗转接用药核对（MRAT）项目的回顾性评估。MRAT包括病历审查以及在收到外部专科医生记录或医院出院小结后与护理人员联系。从该项目获得的数据用于确定患有复杂和非复杂慢性病儿童的用药差异频率和类型。
对124次会诊的MRAT进行了评估，74.0%是针对专科预约。病历审查显示每位患者平均有3.64处差异，电话沟通显示每位患者另有1.39处差异。复杂患者和非复杂患者在病历审查和电话沟通中出现的用药差异数量在统计学上具有显著意义，分别为每位患者平均5.63处和3.77处（p = 0.005）。16.1%的患者因保险拒付、家属未开始使用新药或对用药变化存在困惑而出现治疗延迟。核对所需的平均时间为24分钟。除用药核对外，在MRAT期间完成的107项干预措施包括患者教育、调整药物治疗、协调医护人员之间的护理、推荐实验室监测以及协助患者预约。
慢性病患儿在住院或看专科医生时经常会经历用药变化和治疗延迟。及时识别这些变化可改善沟通，并提供识别和预防药物治疗问题的机会。
