Cancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada.
Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada.
BMJ Open Qual. 2023 May;12(2). doi: 10.1136/bmjoq-2022-002211.
Medication reconciliation (MedRec) is a process where providers work with patients to document and communicate comprehensive medication information by creating a complete medication list (best possible medication history (BPMH)) then reconciling it against what patient is actually taking to identify potential issues such as drug-drug interactions. We undertook an environmental scan of current MedRec practices in outpatient cancer care to inform a quality improvement project at our centre with the aim of 30% of patients having a BPMH or MedRec within 30 days of initiating treatment with systemic therapy.
We conducted semi-structured interviews with key stakeholders from 21 cancer centres across Canada, probing on current policies, and barriers and facilitators to MedRec. Guided by the findings of the scan, we then undertook a quality improvement project at our cancer centre, comprising six iterative improvement cycles.
Most institutions interviewed had a process in place for collecting a BPMH (81%) and targeted patients initiating systemic therapy (59%); however, considerable practice variation was noted and completion of full MedRec was uncommon. Lack of resources, high patient volumes, lack of a common medical record spanning institutions and settings which limits access to medication records from external institutions and community pharmacies were identified as significant barriers. Despite navigating challenges related to the COVID-19 pandemic, we achieved 26.6% of eligible patients with a documented BPMH. However, uptake of full MedRec remained low whereby 4.7% of patients had a documented MedRec.
Realising improvements to completion of MedRec in outpatient cancer care is possible but takes considerable time and iteration as the process is complex. Resource allocation and information sharing remain major barriers which need to be addressed in order to observe meaningful improvements in MedRec.
药物重整（MedRec）是一个过程，医疗保健提供者通过创建完整的药物清单（最佳可能的药物史（BPMH）），与患者一起记录和交流全面的药物信息，然后与患者实际服用的药物进行核对，以确定潜在的问题，如药物相互作用。我们对门诊癌症护理中的当前 MedRec 实践进行了环境扫描，以为我们中心的一个质量改进项目提供信息，目标是在开始接受系统治疗后 30 天内，有 30%的患者有 BPMH 或 MedRec。
我们对来自加拿大 21 个癌症中心的关键利益相关者进行了半结构化访谈，探讨了当前的政策、药物重整的障碍和促进因素。根据扫描结果，我们在我们的癌症中心开展了一个质量改进项目，包括六个迭代改进周期。
大多数接受采访的机构都有收集 BPMH 的流程（81%），并针对开始接受系统治疗的患者（59%）；然而，注意到实践存在很大差异，完整的 MedRec 完成率不高。缺乏资源、患者数量高、机构和环境之间缺乏通用的医疗记录，限制了从外部机构和社区药店获取药物记录的机会，这些都是重大障碍。尽管在 COVID-19 大流行期间遇到了挑战，我们仍实现了 26.6%符合条件的患者有记录的 BPMH。然而，完整的 MedRec 采用率仍然很低，只有 4.7%的患者有记录的 MedRec。
在门诊癌症护理中实现药物重整完成情况的改善是可能的，但需要相当长的时间和迭代，因为这个过程很复杂。资源分配和信息共享仍然是需要解决的主要障碍，以便在药物重整方面取得有意义的改进。
