Abstract:

Background: Accurate medication reconciliation is a crucial aspect of inpatient as well as outpatient medicine and can prevent many medical errors. Electronic health records do not preclude significant discrepancies between documentation and actual patient practice. Thus the best source of information remains the patient himself/herself. In clinical practices worldwide, especially those that cater to populations belonging to low socio-economic groups, getting the patient to bring their medications at their health care visit remains the major challenge.

Methods: Targetting patients visiting a public hospital's primary care clinic, we sought to increase their rates of bringing their medications or medication lists from under 50% to over 75%. We called our outcome of interest the SYM ("show-your-meds") rate. Through application of various quality improvement tools and models including fishbone, tally sheets and the PDSA (plan, do, study, act) technique, we employed and measured the effects of various interventions on improving the SYM rate of our patients.

Results: The quality improvement exercise was carried out over six months, and various tools were employed. A SYM rate that was consistently higher than 75% (and approaching 100%) was achieved with the introduction of a specific, standardized phone message sent out to patients during the week before their healthcare visit. Several barriers to implentation of this and other interventions were also identified along the way and addressed appropriately.

Conclusions: We were able to demonstrate that patients are most likely to bring their medications to clinic if verbally reminded close to the scheduled healthcare visit. Moreover, we identified several barriers to achieving a high SYM rate and also came up with their solutions. Given the considerable burden of time and effort imposed by uncertainty surrounding a patient's current medication intake, we propose that investing into an automated telephone reminder system using a standardized message is cost-effective and worth its while.

Keywords:

Medication reconciliation, quality improvement, primary health care.