J Am Pharm Assoc (2003). 2022 Jul-Aug;62(4):1179-1188.e3. doi: 10.1016/j.japh.2022.01.010. Epub 2022 Jan 17.
Improper medication reconciliation can result in inaccurate medication lists. When medication lists are inaccurate, it can result in drug-drug interactions, dosing errors, and medication duplication. Interventions targeting medication reconciliation have had varying levels of success.
This study aimed to describe the medication reconciliation educational program, its implementation in a health care system, pharmacist and clinic personnel perception of the program, and its impact on clinic personnel knowledge and practice.
Guided by the Conceptual Model of Implementation Research, a partially mixed sequential dominant status evaluation of a pharmacist-led educational program on evidence-based practices for medication reconciliation implemented into all primary care clinic sites by examining implementation outcomes was conducted. The implementation outcomes measured include penetration, fidelity, acceptability, appropriateness, feasibility, and adoption. Data were collected through program data and direct observations, pre- and postsurveys, and semistructured interviews of pharmacists and clinic personnel.
Of 46 primary care sites, 37 primary care sites (80%) implemented the pharmacist-delivered medication reconciliation education from April to June 2021 with representation from each of Geisinger's regions. Ten clinic sites (27%) completed the medication reconciliation educational program as originally designed, with the remainder adapting the program. A total of 296 clinic personnel completed the presurvey, and 178 completed the postsurvey. There were no differences in baseline characteristics between clinic personnel who completed the pre- versus postsurvey. All clinic personnel interviewed felt satisfied with the educational program and felt it was appropriate because it directly affected their job. Clinic personnel felt the educational program was acceptable and appropriate; two major concerns were discussed: a lack of patient knowledge about their medications and a lack of time to complete the medication reconciliation. The adherence rate to the elements of the medication reconciliation that were covered in the education program ranged from 0% to 95% in the 55 observations conducted.
An educational program for medication reconciliation was found to be acceptable and appropriate but was often adapted to fit site-specific needs. Additional barriers affected adoption of best practices and should be addressed in future studies.
不当的用药重整可能导致用药清单不准确。当用药清单不准确时，可能会导致药物相互作用、剂量错误和用药重复。针对用药重整的干预措施取得了不同程度的成功。
本研究旨在描述用药重整教育计划，其在医疗保健系统中的实施情况，药剂师和诊所人员对该计划的看法，以及该计划对诊所人员知识和实践的影响。
在实施研究概念模型的指导下，对一项由药剂师主导的、针对基于证据的用药重整实践的教育计划进行了部分混合顺序主导地位评估，该计划在所有初级保健诊所站点实施，通过检查实施结果来评估实施结果。实施结果包括渗透率、保真度、可接受性、适宜性、可行性和采用率。数据通过方案数据和直接观察、预调查和后调查以及药剂师和诊所人员的半结构化访谈收集。
在 46 个初级保健站点中，有 37 个初级保健站点（80%）于 2021 年 4 月至 6 月实施了由药剂师提供的用药重整教育，代表了 Geisinger 的各个地区。有 10 个诊所（27%）按照最初的设计完成了用药重整教育计划，其余的则对该计划进行了调整。共有 296 名诊所人员完成了预调查，178 名完成了后调查。完成预调查和后调查的诊所人员在基线特征上没有差异。所有接受采访的诊所人员都对教育计划感到满意，并认为该计划是合适的，因为它直接影响到他们的工作。诊所人员认为教育计划是可以接受和合适的；讨论了两个主要关注点：患者对自己药物的知识不足以及完成用药重整的时间不足。在进行的 55 次观察中，对教育计划涵盖的用药重整要素的遵守率在 0%到 95%之间。
发现用药重整教育计划是可以接受和合适的，但往往需要根据具体地点进行调整。其他障碍影响了最佳实践的采用，应该在未来的研究中加以解决。
