Evaluation of Multimedia Medication Reconciliation Software: A Randomized Controlled, Single-Blind Trial to Measure Diagnostic Accuracy for Discrepancy Detection

Lesselroth, Blake J.; Adams, Kathleen; Church, Victoria; Tallett, Stephanie; Russ, Yelizaveta; Wiedrick, Jack; Forsberg, Christopher W.; Dorr, David A.

doi:10.1055/s-0038-1645889

Cited by 11 publications

(10 citation statements)

References 104 publications

(187 reference statements)

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“…8 13 14 In previous facility-level QI pilots within the VA, our team identified an array of sociotechnical issues mediating successful adoption. [15][16][17][18][19][20][21] These findings echo prior research on MR implementation barriers including limited EHR interoperability (including prescription data), poor interface usability, competing organisational priorities, patient-centred social factors (eg, health literacy), and clinician time and staff resource constraints. 5 22-28…”

Section: What This Study Addssupporting

confidence: 58%

“…Typically, sustained improvement in MR processes and clinical outcomes is contingent on a combination of decision support technologies, a strong organisational climate and a schematised workflow. 16 19 24 28 Unfortunately, our findings indicate that VA clinicians struggle with resource and technology gaps. They cited concerns over workflow compatibility and institutional support-including resources, time and leadership prioritisation.…”

Section: Principal Findingsmentioning

confidence: 89%

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Interprofessional survey on medication reconciliation activities in the US Department of Veterans’ Affairs: development and validation of an Implementation Readiness Questionnaire

et al. 2022

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BackgroundMedication reconciliation (MR) can detect medication history discrepancies at interfaces-in-care and help avoid downstream adverse drug events. However, organisations have struggled to implement high-quality MR programmes. The literature has identified systems barriers, including technology capabilities and data interoperability. However, organisational culture as a root cause has been underexplored.ObjectivesOur objectives were to develop an implementation readiness questionnaire and measure staff attitudes towards MR across a healthcare enterprise.MethodsWe developed and distributed a questionnaire to 170 Veterans’ Health Affairs (VHA) sites using Research Electronic Data Capture (REDCap) software. The questionnaire contained 21 Likert-scale items that measured three constructs, such as: (1) the extent that clinicians valued MR; (2) perceptions of workflow compatibility and (3) perceptions concerning organisational climate of implementation.Results8704 clinicians and staff responded to our questionnaire (142 of 170 VHA facilities). Most staff believed reconciling medications can improve medication safety (approximately 90% agreed it was ‘important’). However, most (approximately 90%) also expressed concerns about changes to their workflow. One-third of respondents prioritised other duties over MR and reported barriers associated with implementation climate. Only 47% of respondents agreed they had enough resources to address discrepancies when identified.InterpretationOur findings indicate that an MR readiness assessment can forecast challenges and inform development of a context-sensitive implementation bundle. Clinicians surveyed struggled with resources, technology challenges and implementation climate. A strong campaign should include clear leadership messaging, credible champions and resources to overcome technical challenges.ConclusionsThis manuscript provides a method to conduct a readiness assessment and highlights the importance of organisational culture in an MR campaign. The data can help assess site or network readiness for an MR change management programme.

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Section: What This Study Addssupporting

confidence: 58%

Section: Principal Findingsmentioning

confidence: 89%

Interprofessional survey on medication reconciliation activities in the US Department of Veterans’ Affairs: development and validation of an Implementation Readiness Questionnaire

et al. 2022

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“…Interestingly, results of multicomponent interventions within the primary care setting were more equivocal, with only 7 of the 10 studies reporting positive findings. Furthermore, all of the studies reporting null effects in the primary care setting were randomized controlled trials, 44 , 72 , 85 possibly indicating that bias associated with nonrandomized and observational study designs may be inflating the observed effect estimates in secondary care settings. 94 Inflated positive results, where randomization and blinding are not possible, also raise the possibility of the Hawthorne effect where subjects modify their behavior in response to being observed or measured.…”

Section: Discussionmentioning

confidence: 99%

Optimizing Hospital Electronic Prescribing Systems: A Systematic Scoping Review

et al. 2022

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Objective: Considerable international investment in hospital electronic prescribing (ePrescribing) systems has been made, but despite this, it is proving difficult for most organizations to realize safety, quality, and efficiency gains in prescribing. The objective of this work was to develop policy-relevant insights into the optimization of hospital ePrescribing systems to maximize the benefits and minimize the risks of these expensive digital health infrastructures.Methods: We undertook a systematic scoping review of the literature by searching MEDLINE, Embase, and CINAHL databases. We searched for primary studies reporting on ePrescribing optimization strategies and independently screened and abstracted data until saturation was achieved. Findings were theoretically and thematically synthesized taking a medicine life-cycle perspective, incorporating consultative phases with domain experts.Results: We identified 23,609 potentially eligible studies from which 1367 satisfied our inclusion criteria. Thematic synthesis was conducted on a data set of 76 studies, of which 48 were based in the United States. Key approaches to optimization included the following: stakeholder engagement, system or process redesign, technological innovations, and education and training packages. Single-component interventions (n = 26) described technological optimization strategies focusing on a single, specific step in the prescribing process. Multicomponent interventions (n = 50) used a combination of optimization strategies, typically targeting multiple steps in the medicines management process.Discussion: We identified numerous optimization strategies for enhancing the performance of ePrescribing systems. Key considerations for ePrescribing optimization include meaningful stakeholder engagement to reconceptualize the service delivery model and implementing technological innovations with supporting training packages to simultaneously impact on different facets of the medicines management process.

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“…Similar to MT, this information is imported into the EHR and reviewed by clinicians [ 31 ]. In their evaluation, they found similar rates of discrepancies (29%-39% vs 34%-40%), and the overall number of patients with discrepancies were similar (91%-99% vs 92%-93%) [ 33 , 34 ]. When evaluating the implementation of their application, they also found that time is a factor in using medication reconciliation technology and that, to be taken up, the technology needs to be well integrated into current workflows [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Web-Based Medication Reconciliation Application Within a Primary Care Setting: Cluster-Randomized Controlled Trial

Gionfriddo¹,

Hu²,

Maddineni³

et al. 2022

JMIR Form Res

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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 (eg, pharmacies, other provider/hospital records, and care facilities) and patient-reported use. Advances in the interoperability and digital collection of information provides a foundation for integration of these once disparate information sources. Objective We aim 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 controlled trial of MT in 6 primary care clinics within an integrated health care 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 semistructured interviews. Results Overall, 224 patients were recruited and underwent a BPMH with the pharmacist (n=118 [52.7%] usual care [UC], n=106 [47.3%] MT). For our primary outcome of medication list accuracy, 8 (7.5%) patients in the MT arm and 9 (7.6%) in the UC arm had 0 discrepancies (odds ratio=1.01, 95% CI 0.38-2.72, P=.98). The most common discrepancy identified was patients reporting no longer taking a medication (UC mean 2.48 vs MT mean 2.58, P=.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 data, and pharmacy-dispensed data did not improve medication list accuracy among a population of primary care patients compared to UC but was well received by patients. Future studies should address the limitations of the current application and assess whether improved implementation strategies would impact the effectiveness of the application.

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Evaluation of Multimedia Medication Reconciliation Software: A Randomized Controlled, Single-Blind Trial to Measure Diagnostic Accuracy for Discrepancy Detection

Abstract: ClinicalTrials.gov Identifier: NCT02135731.

Cited by 11 publications

References 104 publications

Interprofessional survey on medication reconciliation activities in the US Department of Veterans’ Affairs: development and validation of an Implementation Readiness Questionnaire

Interprofessional survey on medication reconciliation activities in the US Department of Veterans’ Affairs: development and validation of an Implementation Readiness Questionnaire

Optimizing Hospital Electronic Prescribing Systems: A Systematic Scoping Review

Evaluation of a Web-Based Medication Reconciliation Application Within a Primary Care Setting: Cluster-Randomized Controlled Trial

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