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Aligning Medication Reconciliation and Secure Messaging: Qualitative Study of Primary Care Providers’ Perspectives

BACKGROUND: Virtual (non-face-to-face) medication reconciliation strategies may reduce adverse drug events (ADEs) among vulnerable ambulatory patients. Understanding provider perspectives on the use of technology for medication reconciliation can inform the design of patient-centered solutions to im...

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Autores principales: Heyworth, Leonie, Clark, Justice, Marcello, Thomas B, Paquin, Allison M, Stewart, Max, Archambeault, Cliona, Simon, Steven R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications Inc. 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868963/
https://www.ncbi.nlm.nih.gov/pubmed/24297865
http://dx.doi.org/10.2196/jmir.2793
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author Heyworth, Leonie
Clark, Justice
Marcello, Thomas B
Paquin, Allison M
Stewart, Max
Archambeault, Cliona
Simon, Steven R
author_facet Heyworth, Leonie
Clark, Justice
Marcello, Thomas B
Paquin, Allison M
Stewart, Max
Archambeault, Cliona
Simon, Steven R
author_sort Heyworth, Leonie
collection PubMed
description BACKGROUND: Virtual (non-face-to-face) medication reconciliation strategies may reduce adverse drug events (ADEs) among vulnerable ambulatory patients. Understanding provider perspectives on the use of technology for medication reconciliation can inform the design of patient-centered solutions to improve ambulatory medication safety. OBJECTIVE: The aim of the study was to describe primary care providers’ experiences of ambulatory medication reconciliation and secure messaging (secure email between patients and providers), and to elicit perceptions of a virtual medication reconciliation system using secure messaging (SM). METHODS: This was a qualitative study using semi-structured interviews. From January 2012 to May 2012, we conducted structured observations of primary care clinical activities and interviewed 15 primary care providers within a Veterans Affairs Healthcare System in Boston, Massachusetts (USA). We carried out content analysis informed by the grounded theory. RESULTS: Of the 15 participating providers, 12 were female and 11 saw 10 or fewer patients in a typical workday. Experiences and perceptions elicited from providers during in-depth interviews were organized into 12 overarching themes: 4 themes for experiences with medication reconciliation, 3 themes for perceptions on how to improve ambulatory medication reconciliation, and 5 themes for experiences with SM. Providers generally recognized medication reconciliation as a valuable component of primary care delivery and all agreed that medication reconciliation following hospital discharge is a key priority. Most providers favored delegating the responsibility for medication reconciliation to another member of the staff, such as a nurse or a pharmacist. The 4 themes related to ambulatory medication reconciliation were (1) the approach to complex patients, (2) the effectiveness of medication reconciliation in preventing ADEs, (3) challenges to completing medication reconciliation, and (4) medication reconciliation during transitions of care. Specifically, providers emphasized the importance of medication reconciliation at the post-hospital visit. Providers indicated that assistance from a caregiver (eg, a family member) for medication reconciliation was helpful for complex or elderly patients and that patients’ social or cognitive factors often made medication reconciliation challenging. Regarding providers’ use of SM, about half reported using SM frequently, but all felt that it improved their clinical workflow and nearly all providers were enthusiastic about a virtual medication reconciliation system, such as one using SM. All providers thought that such a system could reduce ADEs. CONCLUSIONS: Although providers recognize the importance and value of ambulatory medication reconciliation, various factors make it difficult to execute this task effectively, particularly among complex or elderly patients and patients with complicated social circumstances. Many providers favor enlisting the support of pharmacists or nurses to perform medication reconciliation in the outpatient setting. In general, providers are enthusiastic about the prospect of using secure messaging for medication reconciliation, particularly during transitions of care, and believe a system of virtual medication reconciliation could reduce ADEs.
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spelling pubmed-38689632013-12-20 Aligning Medication Reconciliation and Secure Messaging: Qualitative Study of Primary Care Providers’ Perspectives Heyworth, Leonie Clark, Justice Marcello, Thomas B Paquin, Allison M Stewart, Max Archambeault, Cliona Simon, Steven R J Med Internet Res Original Paper BACKGROUND: Virtual (non-face-to-face) medication reconciliation strategies may reduce adverse drug events (ADEs) among vulnerable ambulatory patients. Understanding provider perspectives on the use of technology for medication reconciliation can inform the design of patient-centered solutions to improve ambulatory medication safety. OBJECTIVE: The aim of the study was to describe primary care providers’ experiences of ambulatory medication reconciliation and secure messaging (secure email between patients and providers), and to elicit perceptions of a virtual medication reconciliation system using secure messaging (SM). METHODS: This was a qualitative study using semi-structured interviews. From January 2012 to May 2012, we conducted structured observations of primary care clinical activities and interviewed 15 primary care providers within a Veterans Affairs Healthcare System in Boston, Massachusetts (USA). We carried out content analysis informed by the grounded theory. RESULTS: Of the 15 participating providers, 12 were female and 11 saw 10 or fewer patients in a typical workday. Experiences and perceptions elicited from providers during in-depth interviews were organized into 12 overarching themes: 4 themes for experiences with medication reconciliation, 3 themes for perceptions on how to improve ambulatory medication reconciliation, and 5 themes for experiences with SM. Providers generally recognized medication reconciliation as a valuable component of primary care delivery and all agreed that medication reconciliation following hospital discharge is a key priority. Most providers favored delegating the responsibility for medication reconciliation to another member of the staff, such as a nurse or a pharmacist. The 4 themes related to ambulatory medication reconciliation were (1) the approach to complex patients, (2) the effectiveness of medication reconciliation in preventing ADEs, (3) challenges to completing medication reconciliation, and (4) medication reconciliation during transitions of care. Specifically, providers emphasized the importance of medication reconciliation at the post-hospital visit. Providers indicated that assistance from a caregiver (eg, a family member) for medication reconciliation was helpful for complex or elderly patients and that patients’ social or cognitive factors often made medication reconciliation challenging. Regarding providers’ use of SM, about half reported using SM frequently, but all felt that it improved their clinical workflow and nearly all providers were enthusiastic about a virtual medication reconciliation system, such as one using SM. All providers thought that such a system could reduce ADEs. CONCLUSIONS: Although providers recognize the importance and value of ambulatory medication reconciliation, various factors make it difficult to execute this task effectively, particularly among complex or elderly patients and patients with complicated social circumstances. Many providers favor enlisting the support of pharmacists or nurses to perform medication reconciliation in the outpatient setting. In general, providers are enthusiastic about the prospect of using secure messaging for medication reconciliation, particularly during transitions of care, and believe a system of virtual medication reconciliation could reduce ADEs. JMIR Publications Inc. 2013-12-02 /pmc/articles/PMC3868963/ /pubmed/24297865 http://dx.doi.org/10.2196/jmir.2793 Text en ©Leonie Heyworth, Justice Clark, Thomas B Marcello, Allison M Paquin, Max Stewart, Cliona Archambeault, Steven R Simon. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.12.2013. http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Heyworth, Leonie
Clark, Justice
Marcello, Thomas B
Paquin, Allison M
Stewart, Max
Archambeault, Cliona
Simon, Steven R
Aligning Medication Reconciliation and Secure Messaging: Qualitative Study of Primary Care Providers’ Perspectives
title Aligning Medication Reconciliation and Secure Messaging: Qualitative Study of Primary Care Providers’ Perspectives
title_full Aligning Medication Reconciliation and Secure Messaging: Qualitative Study of Primary Care Providers’ Perspectives
title_fullStr Aligning Medication Reconciliation and Secure Messaging: Qualitative Study of Primary Care Providers’ Perspectives
title_full_unstemmed Aligning Medication Reconciliation and Secure Messaging: Qualitative Study of Primary Care Providers’ Perspectives
title_short Aligning Medication Reconciliation and Secure Messaging: Qualitative Study of Primary Care Providers’ Perspectives
title_sort aligning medication reconciliation and secure messaging: qualitative study of primary care providers’ perspectives
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868963/
https://www.ncbi.nlm.nih.gov/pubmed/24297865
http://dx.doi.org/10.2196/jmir.2793
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