Addressing meaningful use and maintaining an accurate medication list in primary care.

OBJECTIVES: The primary objective of this project was to determine the difference in medication list accuracy between an initial and follow-up medication reconciliation visit in a primary care office. Secondary objectives were to identify the difference in medication-related problems most commonly encountered during the visits, factors that may influence patient understanding of their medication regimen, and physician perceptions of the medication review visit.

SETTING: Quasi-experimental study part of a larger pilot project to address the ability of how health information technology can be used to maintain an active medication list.

PRACTICE DESCRIPTION: Three family medicine residency clinics in the Midwest. Adult patients with diabetes or chronic obstructive pulmonary disease who had 6 or more long-term medications listed in the electronic health record (EHR) were recruited to participate.

PRACTICE INNOVATION: An initial comprehensive medication reconciliation visit was conducted by a resident physician and a pharmacist with the goal of ensuring an accurate, easy-to-follow, electronically developed medication list. A follow-up visit with the pharmacist occurred 3-6 months after the initial visit.

EVALUATION: Medication list accuracy and medication-related problems were assessed at the initial and follow-up visits. Patient-related factors that could affect medication understanding were collected at the initial visit with status of enrollment in the EHR patient portal.

RESULTS: Fifty-seven of 65 patients completed the study. The number of patients with an accurate medication list increased from 40% to 49% (P = 0.38). The number of medication-related problems decreased from 146 to 91 (P < 0.001). The use of special tools (e.g., pillboxes) was associated with fewer medication regimen errors (P = 0.036). Patients enrolled in the EHR patient portal were more likely to know the purpose of their medications as compared with those not enrolled (P = 0.019).

CONCLUSION: An intentionally scheduled medication review with a primary care provider and pharmacist did not significantly improve the accuracy of the medication list, but it was associated with fewer drug-related problems.