Phang Yen Yen, Kuan Jew Win, Oh Ai Ling, Ting Chuo Yew, Osman Nor Anizah, Moses Stephen
Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Malaysia.
Pharmacy Service Division, Sarawak State Health Department, Ministry of Health, Kuching, Malaysia.
BMC Prim Care. 2025 Jul 2;26(1):206. doi: 10.1186/s12875-025-02904-z.
Modifications to medication regimens during transitions of care between different healthcare settings often lead to unintentional medication discrepancies (UMDs). The MedBook Portal, a simple digital platform that enables the sharing of patient medication records among healthcare facilities under Ministry of Health, was developed to facilitate medication reconciliation at primary health clinic (PHC) after hospital discharge. This study aimed to determine the effectiveness of MedBook Portal in reducing UMDs in the first prescription during the first PHC visit after hospital discharge.
This two-arm, parallel, non-blinded, randomised controlled trial was conducted at four public hospitals and ten public PHCs in Sarawak, Malaysia, from May 2023 to July 2024. Adult patients aged ≥ 18 years in general medical wards, discharged from hospitals, and referred to selected PHCs were recruited. In the Standard Care group, PHC doctors performed standard medication reconciliation by reviewing patients' medical records on their home-based medical cards and discharge notes, if available. In the MedBook Portal group, in addition to this process, PHC doctors logged into MedBook Portal to access the discharge prescription before issuing a new prescription.
Among the 339 eligible subjects randomised into MedBook Portal group and Standard Care group, 307 participants (147 MedBook Portal, 160 Standard Care) were analysed after excluding those for whom the intervention was not performed (n = 11) and those with no prescription (n = 21). The incidence rate of prescription with UMDs was significantly lower in the MedBook Portal group (5/147, 3.4%) compared to the Standard Care group (30/160, 18.8%) (p < 0.001). The most common UMD was drug omission (54.4%). Multivariable logistic regression showed that the presence of MedBook Portal reduced the odds of UMDs by 87% (adjusted OR 0.134, 95% CI 0.049-0.336, p < 0.001), whereas each additional comorbidity increased the odds by 52% (adjusted OR 1.520, 95% CI 1.158-2.020, p = 0.003).
Medication reconciliation using the MedBook Portal effectively reduces UMDs during the transition of care from hospital discharge to PHCs, enhancing patient safety across the continuum of care.
ClinicalTrials.Gov (NCT06517160) was registered retrospectively on 19 September 2024.
在不同医疗机构之间的护理转接过程中，调整药物治疗方案常常会导致无意的用药差异（UMD）。MedBook门户是一个简单的数字平台，可实现卫生部下属医疗机构之间共享患者用药记录，其开发目的是便于患者出院后在初级卫生诊所（PHC）进行用药核对。本研究旨在确定MedBook门户在减少出院后首次PHC就诊时首张处方中的UMD方面的有效性。
本双臂、平行、非盲、随机对照试验于2023年5月至2024年7月在马来西亚砂拉越的四家公立医院和十家公立PHC进行。招募年龄≥18岁、从综合内科病房出院并转诊至选定PHC的成年患者。在标准护理组中，PHC医生通过查看患者家庭医疗卡上的病历和出院小结（如有）进行标准用药核对。在MedBook门户组中，除了这一流程外，PHC医生在开具新处方前登录MedBook门户以获取出院处方。
在随机分为MedBook门户组和标准护理组的339名符合条件的受试者中，排除未接受干预的受试者（n = 11）和无处方的受试者（n = 21）后，对307名参与者（147名MedBook门户组，160名标准护理组）进行了分析。MedBook门户组首张处方存在UMD的发生率（5/147，3.4%）显著低于标准护理组（30/160，18.8%）（p < 0.001）。最常见的UMD是药物遗漏（54.4%）。多变量逻辑回归显示，MedBook门户的使用使UMD的几率降低了87%（调整后的OR为0.134，95%CI为0.049-0.336，p < 0.001），而每增加一种合并症，几率增加52%（调整后的OR为1.520，95%CI为1.158-2.020，p = 0.003）。
使用MedBook门户进行用药核对可有效减少从出院到PHC护理转接过程中的UMD，提高整个护理过程中的患者安全性。
ClinicalTrials.Gov（NCT06517160）于2024年9月19日进行了回顾性注册。
