Gionfriddo Michael R, Duboski Vanessa, Middernacht Allison, Kern Melissa S, Graham Jove, Wright Eric A
Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States of America.
Wilkes University School of Pharmacy, Wilkes-Barre, PA, United States of America.
PLoS One. 2021 Dec 2;16(12):e0260882. doi: 10.1371/journal.pone.0260882. eCollection 2021.
To understand the extent to which behaviors consistent with high quality medication reconciliation occurred in primary care settings and explore barriers to high quality medication reconciliation.
Fully mixed sequential equal status design including ethnographic observations, semi-structured interviews, and surveys.
Primary care practices within an integrated healthcare delivery system in the United States.
We conducted 170 observations of patient encounters across 15 primary care clinics, 48 semi-structured interviews with staff, and 10 semi-structured interviews with patients. We also sent out surveys to 2,541 eligible staff with 616 responses (24% response rate) and to 5,132 eligible patients with 577 responses (11% response rate).
Inconsistency emerged as a major barrier to effective medication reconciliation. This inconsistency was present across a variety of factors such as the lack of standardized workflows for conducting medication reconciliation, a lack of knowledge about medication and the process of medication reconciliation, varying levels of importance ascribed to medication reconciliation, and inadequate integration of medication reconciliation into clinical workflows. Findings were generally consistent across all data collection methods.
We have identified several barriers which impact the process of medication reconciliation in primary care settings. Our key finding is that the process of medication reconciliation is plagued by inconsistencies which contribute to inaccurate medication lists. These inconsistencies can be broken down into several categories (standardization, knowledge, importance, and inadequate integration) which can be targets for future studies and interventions.
了解在初级保健机构中符合高质量药物重整的行为出现的程度，并探讨高质量药物重整的障碍。
完全混合的顺序平等地位设计，包括人种学观察、半结构化访谈和调查。
美国一个综合医疗服务体系内的初级保健机构。
我们对15家初级保健诊所的患者诊疗过程进行了170次观察，对工作人员进行了48次半结构化访谈，对患者进行了10次半结构化访谈。我们还向2541名符合条件的工作人员发放了调查问卷，收到616份回复（回复率24%），向5132名符合条件的患者发放了调查问卷，收到577份回复（回复率11%）。
不一致成为有效药物重整的主要障碍。这种不一致存在于多种因素中，例如缺乏进行药物重整的标准化工作流程、对药物及药物重整过程缺乏了解、对药物重整的重视程度不同，以及药物重整在临床工作流程中的整合不足。所有数据收集方法的结果总体一致。
我们确定了几个影响初级保健机构中药物重整过程的障碍。我们的主要发现是，药物重整过程受到不一致性的困扰，这导致了药物清单不准确。这些不一致性可分为几类（标准化、知识、重要性和整合不足），可作为未来研究和干预的目标。
