NY Times. 2011, June 15
Author: Paula Span
The Institue of Medicine proposed a universal medication schedule makes taking medications simpler:
George, Mark and Wes have been working on a project to reduce medication errors and improve understanding and adherence to drug regimens at home. We now have an exciting prototype that we’d like to share with you.
As clinicians, we have seen that all too often medication is not taken as directed. By some conservative estimates, unintended mistakes involving prescription drugs harm at least 1.5 million Americans each year. These errors result in $3.5 billion in extra medical costs and a great deal of illness and suffering.
We believe many of these errors can—and should—be prevented. With this goal in mind, we formed the Medication Safety Foundation, a California nonprofit 501(c)(3) organization focused on introducing a simple, inexpensive system for patients and their caregivers of all literacy and educational backgrounds.
Our prescription-tracking product—an easy-to-follow calendar—will help people correctly organize and take their prescriptions at home and in other outpatient settings. Users match their actual pills to images on the calendar according to the time and the day they need to take them. The calendar is available online, and can be printed as a worksheet or guide for patients who aren’t computer savvy. We would like to develop a mobile app, too.
For many patients and their families, keeping track of a prescription regimen is a complicated, ongoing struggle. Some patients buy pill caddies or devise their own pill-taking strategies. Unfortunately, such efforts often fail. The consequences of improperly administered medications include ineffective treatment for underlying conditions, along with serious or life-threatening side effects.
Our calendar is confidential and is designed with the patient as the center of the process. It provides patients with a clear map of the day’s medicines, illustrating when and how many to take.
Because the system is “owned” by patients, the calendar remains with them, even when they change insurance or move. It’s simple to make changes whenever they come up.
We believe our system will make a big difference—improving the lives of many patients, especially the elderly, the frail and those with low literacy skills. We are now ready to take the next steps so we can transform our prototype into a ready-to-use product and begin demonstrating it to patients, medical professionals and others.
To do so, the foundation needs grants and donations from people like you. Your tax-deductible contribution will provide vital support for our mission of reducing the human and financial toll of avoidable medication errors.
We would be delighted to share more with you about this important project. Please contact us with your questions or comments.
Thanks for your interest and support!
The Medication Safety Foundation team
The area of patient adherence and complex medication regimes has been of special interest to the directors as a result of personal experience and their observation of the impact of poor adherence on the success of treatment.
The Medication Safety Foundation is devoted to working on solutions for this difficult area. Our foundation is a nonprofit corporation located in northern California and started in 2008 to help patients and care givers manage their medicines safely and effectively.
Wesley Lisker has been a practicing internist and nephrologist for 30 years. For most of this time, he has also been closely involved in the areas of hospital quality and safety, physician quality, disease management and quality improvement. He graduated with a BA in neurobiology, a multidisciplinary major, from Berkeley in 1975, and with a MD from St Louis University in 1979. He completed his internship and residency in internal medicine at Jewish Hospital of St Louis, Kaiser Foundation Hospital, Oakland, CA, and Santa Clara Valley Medical Center in San Jose, CA. He received his nephrology fellowship from Stanford University.
As a practicing nephrologist and internist, he has personally cared for several thousand patients with chronic renal failure, kidney dialysis and organ transplants. Many of these patients are on complex medication regimens, often exceeding 10 different daily medicines taken in multiple numbers. He has had a deep interest in epidemiology, population health, performance improvement, quality and safety, and for nearly two decades served as the chief of quality for his medical center which cares for over 250,000 individuals in northern California. He currently has an administrative role in his medical group's hospital quality and safety efforts, and has been involved with, initiated or managed quality improvement efforts ranging from reducing mortality in certain disease entities, to hiring the first case manager in end stage renal disease and helping initiate a peritoneal dialysis program for the medical center. In addition, he has maintained a medicine practice of mostly elderly adults, continues his sub-specialty work in kidney diseases and dialysis, and attends at two dialysis clinics.
While great strides have been to eliminate medication errors in the hospital setting, he is delighted to be able to contribute to the development of this program which focuses on patients at home. The Foundation's patient-centered program has already helped his own patients manage their medicines better. He hopes it will address the potentially dangerous confusion over medications which exists among patients, especially low-literacy ones, their family and caregivers in the community by helping them track their medication regimen and communicate its changes more effectively with their physicians, care-managers and other professionals.Read full story here.
George Lai has worked as both a nephrologist and as a technology enthusiast for all of his career. He graduated with a BA in biology, but minored in computer science, from Brown University in 1992. After his medical education at Ohio State and internship and residency at UC, Irvine, he went on to a nephrology fellowship at Stanford University. During fellowship, he started to work with simple MS Access databases for his project.
When he began his work as a staff nephrologist, George developed a database to track the maturity of vascular accesses in dialysis patients along with the problems which would arise. This work has evolved to help assure the optimal vascular access for patients starting on dialysis.
His work as organizational chair of the nephrology technology leads helped George develop population management software to help address specific needs of patients with chronic kidney disease. Ths work may eventually help guide primary care physicians on how to treat their CKD patients even before they see a nephrologst.
Although George's special interests are database information technology as well as web user interface programming, responsive design (RD) as it relates to the user interface is of special interest. As more and more of users' - and therefore or patients' - interactions with computers are through mobile devices, it will become increasingly important to design an interface which not only fits a desktop window but looks great on a mobile device as well. RD and native mobile designs will play a large role in creating a great interface. Look for more updates in this field in the near future.
Mark has 28 years of experience as a clinical pharmacist since graduating from the University of California, San Francisco, School of Pharmacy, and completing post-graduate work at Duke University Medical Center. He has extensive experience in hospital-based pharmacy system, home health care, and most recently, medical information services. His areas of interest include patient safety, treatment of infectious diseases, and pharmacoeconomics.
NY Times. 2011, June 15
Author: Paula Span
The Institue of Medicine proposed a universal medication schedule makes taking medications simpler:
Ann Intern Med. 2014;160(7):441-450. doi:10.7326/M13-1705
Authors: Robyn Tamblyn, PhD; Tewodros Eguale, MD, PhD; Allen Huang, MD; Nancy Winslade, PharmD; and Pamela Doran, MSc
Background: Primary nonadherence is probably an important contributor to suboptimal disease management, but methodological challenges have limited investigation of it.
Objective: To estimate the incidence of primary nonadherence in primary care and the drug, patient, and physician characteristics that are associated with nonadherence.
Design: A prospective cohort of patients and all their incident prescriptions from primary care electronic health records between 2006 and 2009 linked to provincial drug insurer data on all drugs dispensed from community-based pharmacies were assembled.
Setting: Quebec, Canada.
Patients: 15 961 patients in a primary care network of 131 physicians.
Measurements: Primary nonadherence was defined as not filling an incident prescription within 9 months. Multivariate alternating logistic regression was used to estimate predictors of nonadherence and account for patient and physician clustering.
Results: Overall, 31.3% of the 37 506 incident prescriptions written for the 15 961 patients were not filled. most expensive Drugs in the upper quartile of cost were least likely to be filled (odds ratio [OR], 1.11 [95% CI, 1.07 to 1.17]), as were skin agents, gastrointestinal drugs, and autonomic drugs, compared with anti-infectives. Reduced odds of nonadherence were associated with increasing patient age (OR per 10 years, 0.89 [CI, 0.85 to 0.92]), elimination of prescription copayments for low-income groups (OR, 0.37 [CI, 0.32 to 0.41]), and a greater proportion of all physician visits with the prescribing physician (OR per 0.5 increase, 0.77 [CI, 0.70 to 0.85]).
Limitation: Patients' rationale for choosing not to fill their prescriptions could not be measured.
Conclusion: Primary nonadherence is common and may be reduced by lower drug costs and copayments, as well as increased follow-up care with prescribing physicians for patients with chronic conditions.
Primary Funding Source: Canadian Institutes of Health Research.
Br J Clin Pharmacol. 2011 Mar;71(3):449-57. doi: 10.1111/j.1365-2125.2010.03834.x.
Authors: Grimes TC1, Duggan CA, Delaney TP, Graham IM, Conlon KC, Deasy E, Jago-Byrne MC, O' Brien P.
Aims: Movement into or out of hospital is a vulnerable period for medication safety. Reconciling the medication a patient is using before admission with the medication prescribed on discharge, and documenting any changes (medication reconciliation) is recommended to improve safety. The aims of the study were to investigate the factors contributing to medication reconciliation on discharge, and identify the prevalence of non-reconciliation.
Methods: The study was a cross-sectional, observational survey using consecutive discharges from purposively selected services in two acute public hospitals in Ireland. Medication reconciliation, potential for harm and unplanned re-admission were investigated.
Results: Medication non-reconciliation was identified in 50% of 1245 inpatient episodes, involving 16% of 9569 medications. The majority of non-reconciled episodes had potential to result in moderate (63%) or severe (2%) harm. Handwritten rather than computerized discharges (adjusted odds ratio (adjusted OR) 1.60, 95% CI 1.11, 2.99), increasing number of medications (adjusted OR 1.26, 95% CI 1.21, 1.31) or chronic illness (adjusted OR 2.08, 95% CI 1.33, 3.24) were associated with non-reconciliation. Omission of endocrine, central nervous system and nutrition and blood drugs was more likely on discharge, whilst omission on admission and throughout inpatient care, without documentation, was more likely for obstetric, gynaecology and urinary tract (OGU) or respiratory drugs. Documentation in the discharge communication that medication was intentionally stopped during inpatient care was less likely for cardiovascular, musculoskeletal and OGU drugs. Errors involving the dose were most likely for respiratory drugs.
Conclusions: The findings inform strategies to facilitate medication reconciliation on discharge from acute hospital care.
Ann Emerg Med. 2009 Apr;53(4):454-461.e15. doi: 10.1016/j.annemergmed.2008.05.016. Epub 2008 Jul 10.
Authors: Engel KG1, Heisler M, Smith DM, Robinson CH, Forman JH, Ubel PA.
Objective: To be able to adhere to discharge instructions after a visit to the emergency department (ED), patients should understand both the care that they received and their discharge instructions. The objective of this study is to assess, at discharge, patients' comprehension of their ED care and instructions and their awareness of deficiencies in their comprehension.
Methods: We conducted structured interviews of 140 adult English-speaking patients or their primary caregivers after ED discharge in 2 health systems. Participants rated their subjective understanding of 4 domains: (1) diagnosis and cause; (2) ED care; (3) post-ED care, and (4) return instructions. We assessed patient comprehension as the degree of agreement (concordance) between patients' recall of each of these domains and information obtained from chart review. Two authors scored each case independently and discussed discrepancies before providing a final concordance rating (no concordance, minimal concordance, partial concordance, near concordance, complete concordance).
Results: Seventy-eight percent of patients demonstrated deficient comprehension (less than complete concordance) in at least 1 domain; 51% of patients, in 2 or more domains. Greater than a third of these deficiencies (34%) involved patients' understanding of post-ED care, whereas only 15% were for diagnosis and cause. The majority of patients with comprehension deficits failed to perceive them. Patients perceived difficulty with comprehension only 20% of the time when they demonstrated deficient comprehension.
Conclusion: Many patients do not understand their ED care or their discharge instructions. Moreover, most patients appear to be unaware of their lack of understanding and report inappropriate confidence in their comprehension and recall.