JMIR Publications

ABSTRACT

Background:

Despite routine review of medication lists during patient encounters, patients’ medication lists are often incomplete and not reflective of actual medication use. Contributing to this situation is the challenge of reconciling medication information from existing health records, along with external locations (e.g. pharmacies, other provider/hospital records and care facilities). Advances in interoperability and digital collection of information provides a foundation for integration of these once disparate information sources.

Objective:

Using mixed-methods, we aimed to evaluate the effectiveness of and satisfaction with an electronic health record (EHR) integrated web-based medication reconciliation application, MedTrue™ (MT).

Methods:

We conducted a cluster randomized trial of MT in six primary care clinics within an integrated healthcare delivery system. Our primary outcome was medication list accuracy as determined by a pharmacist collected best possible medication history (BPMH). Patient and staff perspectives were evaluated through surveys and semi-structured interviews.

Results:

Overall, 224 patients were recruited and underwent a BPMH with the pharmacist (118 usual care, 106 MT). For our primary outcome of medication list accuracy, 7.5% in MT and 7.6% in usual care had zero discrepancies (OR=1.01, 95% CI 0.38-2.72, P=0.98). The most common discrepancy identified was patient-reported medication no longer taking (2.48 UC vs. 2.58 MT, P=0.21). Patients found MT easy to use and on average would highly recommend MT (average net promoter score 8/10). Staff found MT beneficial, but difficult to implement.

Conclusions:

The use of a web-based application integrated into the EHR which combines EHR, patient reported, and pharmacy dispense data did not improve medication list accuracy among a population of primary care patients compared to usual care, but was well received by patients. Future studies should address the limitations of the current application and assess whether improved implementation strategies impact the effectiveness of the application.