DRAFT

SOS Rx Coalition

Personal Medication Record Subcommittee Meeting

Discussion Notes

 

June 3, 2004

 

I. Introductions and Meeting Overview

 

The group agreed that the following statement would inform the days discussion:

 

Consumers should have a role in ensuring that a complete, accurate, and updated list of medications and supplements is available to all of their medical care providers so as to maximize therapeutic benefit and minimize the risk of adverse reactions.

 

II. Discussion of Existing PMR Efforts

Marc Boutin of the National Health Council indicated that the Councils Putting Patients First educational campaign, which will launch in September, may be an opportunity to incorporate the SOS Rx Coalitions efforts regarding the personal medication record because part of the campaigns goal is to promote electronic medical records.

 

Francesca Cunningham of the Veterans Administration said the agency would soon enter phase two of its My Health eVet pilot project, which will provide an online prescription medication record for veterans.

 

Lygeia Ricciardi of the Markle Foundation explained that the Connecting for Health program they are coordinating is addressing barriers to electronic connectivity in the United States regarding health care. This fall, they will release consumer messaging related to electronic health records and personal health records.

 

Suzanne Mintz of the National Family Caregivers Association noted that November is National Family Caregivers month and is therefore a good time for public education efforts.

 

III. Broader issues that need to be addressed for this PMR project

The group identified the following issues for possible consideration in developing a PMR template. It was determined that, while many of these issues are important, they do not all need to be addressed specifically by the SOS Rx Coalition. These issues below were acknowledged as being part of the framework for current and future discussion.

 

  1. Technical security
  2. Global privacy
  3. Liability hinders patients ability to get information
  4. Responsibility denial
  5. Ownership of record
  6. Paper-based (interim step)
  7. Conveying information to patients: patient education target audiences, repeat messages
  8. Keep it simple, essential
  9. Who determines what is correct information
  10. Patients crossing over different systems
  11. Need to accommodate complexity of treatments for diseases
  12. Who acts on information provider role
  13. Review of drug efficacy
  14. New errors
  15. Evidence-based knowledge about best way to keep record
  16. Incentives/disincentives
  17. Link PMR to information that can drive behavior change
  18. Accuracy avoid transmitting errors
  19. Process of evaluation
  20. Present template as part of a process (continuum of care)
  21. Expectations of others (e.g., doctors asking if medication list has been updated)
  22. Validation of information on record
  23. Medication Therapy Management (being developed under current Medicare law make PMR a part of that?)
  24. How do we get buy in from stakeholders?
  25. Clear health communication consult experts, test messages
  26. Change of relationship between providers, patients
  27. Physically protecting list of medications
  28. Role of pharmacist key (adherence, polypharmacy)
  29. Scope of list not just pills, liquids
  30. Difference between whats taken and whats prescribed
  31. Alternative providers

 

IV. Discussion of PMR Template - General Questions and Issues to Consider

 

Q      Would it be appropriate to develop one or multiple template versions to account for factors such as patient age, gender, and number/severity of chronic conditions?

A       All patients should note same information, so only one template is necessary; it was acknowledged that this template may need to be updated with varying frequency depending on certain factors (e.g., patient age, chronic conditions).

      Products with intermittent use need to be indicated (e.g., When I have a headache, I take .)

      Need to keep pediatric patients in mind, especially with regard to dosage.

 

Q      Is there a need to indicate the source of medication purchase (e.g., pharmacy or online)? Is there a need to indicate whether a medication was obtained as a sample?

A       This issue was discussed, but it was determined that source is not a critical element for the PMR as it is not a strong risk factor for medication errors/events.

 

Q      Given the need to target those with higher risk of interactions (at least initially), what particular data points are critical risk factors?

A       Although we need to focus on constants that apply to everyone, primary risk factors are 1) use of numerous medications (five medications or more), 2) number of prescribing physicians, and 3) patient age.

 

Other Miscellaneous Points:

      Times of updating PMR must be clear.

      Need to know which doctor prescribed it? Contact information key.

      Primary uses of PMR: convey information to doctor, medication management, patient empowerment

      Public education regarding PMR should engage all stakeholders, but target doctors, LPNs, pharmacists, pharmacy clerks

 

V. Specific Information to Include in the PMR Template

 

1. Demographic Data

 

      Patient name

      Multiple phone numbers (e.g., cell, work, home)

      Birth date

      Names and phone numbers of all prescribing providers (indicate specialty)

      Emergency contact name and number

 

2. Experience Data

 

      Current chronic conditions/associated indications for medications

 

3. Medication Data

 

      Current prescription medications

      Current OTC medications

      Current vitamins, herbals, or other supplements

      Allergies (foods, medications)/ intolerances/bad reactions

      Indicate regular versus intermittent use (check box)

      Note in instructions to list all drugs including samples, patches, liquid formulas, etc

 

4. Level of detail for prescription medications

 

      Dose strength (e.g. 20 mg)

      Dose frequency (e.g., once a day)

      Start date (and stop date?)

      Check off field to indicate last update by patient

      Direct patient to have provider review record (but no sign off by provider)

      Legal disclaimer re: provider review?

 

(Note: prescribers and indications already included in points 2 and 3)

 

5. Level of detail for OTC medications

 

      Same as for prescription medications

 

6. Template layout

 

      Patient ownership of information is key

      Pharmacist role in maintaining accuracy is key

      Focus group test different people may need different formats

      Purpose: ease of portability

      Need for accuracy, updated information, portability

7. Patient/Physician review and update of PMR

 

      At least twice a year

      When starting a new medication

      When stopping a medication

      When there is a change of dose in medication

      Physician review - at every visit

 

V. Next Steps

Report at June 30th coalition meeting

Will review broader issues

Draft template PMR and circulate to this group for feedback and approval

Coalition approval of PMR

Dissemination - Follow up with other initiatives on how to integrate the PMR with other efforts, AHRQ small conference grant?