Action Agenda: SOS Rx Projects

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SOS Rx Personal Medication Record Project

Summary of studies on the use of Personal Medication Records

September 9, 2004

 

This brief summary presents the results of our cursory review of the Pub Med/Medline databases for articles and abstracts on the topic of personal medication records (PMR). 

 

§             Published data on the topic of PMRs appears to be limited.  There are a handful of evaluations that have been conducted, largely at the individual institution (e.g., physician office or hospital) level. 

 

§             Most of these studies attempt to evaluate patient compliance with PMR use, as well as accuracy and completeness of recorded information. 

 

§             Some of the studies involved cards that were originally filled out by the physician, not the patient.

 

§             Study results varied depending on the outcomes measured:

 

o       Some studies found that use of PMRs helped reduce errors because it enabled patients to become more familiar with/better manage the medications they are taking. 

o       Other studies found little benefit from use of PMRs, but identified patient non-compliance as the primary reason.  When PMRs were inaccurate, it was determined to be associated with the patient’s failure to either update it themselves or to present it to their doctor or pharmacist to update.

 

 

Are Medication Record Cards Useful?

Atkin PA, Finnegan TP, Ogle SJ, Shenfield GM.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7715491

 

Med. J Aust.  1995  Mar 20; 162 (6): 300-1

Comment in:

Med J Aust. 1995 Jul 3;163(1):52-3.

Med J Aust. 1995 Jul 3;163(1):53.

Royal North Shore Hospital, Sydney, NSW.

OBJECTIVE: To assess the use of patient-held medication record cards and their acceptability to patients and doctors. DESIGN: Prospective 12-month study with data collection at baseline and on three subsequent occasions at four-monthly intervals. PATIENTS AND SETTING: 187 patients with a mean age of 78.4 years (range, 60-101) were taking a mean of 5.8 medications each (range, 1-18). They lived on Sydney's lower north shore and were able to care for themselves. MAIN OUTCOME MEASURES: Availability of card on request, frequency of use, status of recorders and accuracy of records (checked by inspection of medications at home). RESULTS: Most patients retained their cards, but the proportion who presented it to their doctor fell from 61% to 23% over the 12 months (P < 0.0001), and the proportion with accurately recorded drug regimens ranged from 20% down to 16%. Of the 75 regimens written exclusively by general practitioners in the 12 months, only 19 (25%) were consistent with what the patients were actually taking. CONCLUSION: Medication record cards introduced into the doctor-patient relationship by a "third-party" are unlikely to result in better quality use of medicines.  It is unclear if medication cards issued by physicians directly to their patients would be used more effectively.

 

 

           

Medication cards for elderly people: a study.
Whyte LA.
Nurs Stand. 1994 Aug 24-30;8(48):25-8.

 

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7947128

 

This study describes the benefits of providing patients aged 60 years and over with supplementary written information about their medication regimes. The aim of the study was to measure the effect of a personal medication record card on the information patients could recall about their medication following discharge from hospital. The results demonstrated that the card was favoured by patients and proved effective in assisting them to recall correctly information relating to the name, purpose and special instructions attached to their medicines, as well as helping to reduce errors in administration.

 

 

A patient –held medication record and a patient medication profile to support the continuity of acute cancer care.

Int J Pharm Pract 2001:9 (suppl): R40   

J. Kelly, F. Forrest and S. Hudson

http://www.pjonline.com/IJPP/bpc2001/ijpp_bpc2001_r40.pdf

 

A patient held medication record identified over 90 percent of patient’s medications but was “forgotten” by patients in a third of the contacts with a pharmacist.  The patient held record had little impact on the accuracy of the practitioners records and its value lies more in facilitating patient education than rectifying errors in documentation.  

 

 

The influence of information provided by patients on the accuracy of medication records.

Atkin PA, Stringer RS, Duffy JB, Elion C, Ferraris CS, Misrachi SR, Shenfield GM.

Med J Aust. 1998 Jul 20; 169 (2) 85-8.

Erratum in: Med J Aust 1998 Nov 2;169(9):468


Department of Clinical Pharmacology, Royal North Shore Hospital, Sydney, NSW. patkin@pharm.usyd.edu.au

OBJECTIVE: To assess two interventions for improving the accuracy of doctors' information about their patients' medication. DESIGN AND SETTING: A 12-month two-armed (parallel designed) prospective study among elderly patients of four general practitioners (GPs) in two local government areas of Sydney's North Shore. PATIENTS: 206 elderly, ambulant, self-caring patients (69 men, 137 women; median age, 75 year; range, 60-94 years). INTERVENTION: Patients were issued with a medication record card (MRC), filled in by their GPs with what they believed to be the patient's current medications, and were asked to produce it at all subsequent consultations. Patients of two of the GPs were additionally asked to bring their currently used medications to all scheduled appointments. MAIN OUTCOME MEASURE: Accuracy of the MRC, determined by confirmatory home visits and inspection of medications by a pharmacist. RESULTS: The proportion of patients with regimens recorded accurately on their MRCs improved significantly (from 25.9% to 42.0%) only in the group asked to bring their medications to consultations (P = 0.03). Most errors of recording were of omission, with patients taking a median of two medications (range, 0-10) of which their GPs were not aware. CONCLUSION: Requesting that patients bring their medications to consultations, in conjunction with the use of medication record cards, can improve information for doctors about their patients' medications.

 

 

Medication compliance problems in general practice: detection and intervention by pharmacists and doctors.
Aust J Rural Health.  2002 Feb; 10(1):  33-8.

Bonner CJ, Carr B.
cbonner@bigpond.net.au

Medication compliance; the role of a portable Medical Summary Card as a compliance aid; and the role of a medical practice-based clinical pharmacist in identifying medication-related problems in a rural general practice setting is evaluated. A clinical pharmacist checked the medications of 50 predominantly aged patients against their medical summary and noted inconsistencies and potential medication problems. From this information the general practitioner (GP) assessed patient compliance with prescribed medications and transcribed the correct medication regimen and medical problems onto a Medical Summary Card for the patient to carry. Forty per cent of the patients were non-compliant. A Medical Summary Card alone was unable to improve compliance. Issues noted by the clinical pharmacist warranted a change in therapy for 8% of patients. Eighteen per cent of patients provided medical information to the clinical pharmacist of which the GP was unaware. Non-compliance with prescribed medications is common. A portable Medical Summary Card may not rectify this problem. Patients' withholding medical information from their medical practitioner is of particular concern.


 

American Medical Association Paper -

Report 2 of the Council on Scientific Affairs (I-98) Full Text
Physician Education of Their Patients About Prescription Medicines
http://www.ama-assn.org/ama/pub/article/2036-2515.html

Objectives.  This Council on Scientific Affairs (CSA) report responds to referred Resolution 501 (I-97) and addresses the topic of physician education of their patients about prescription medicines. The report includes an overview of medication compliance, discusses the development and AMA Board of Trustees' approval of Guidelines for Physicians for Counseling Patients About Prescription Medications in the Ambulatory Setting, evaluates the role of patient medication cards in routine medication reviews, and offers recommendations for physicians and the AMA.

Results.  The report documents that medication noncompliance is a serious problem for a wide range of diseases, resulting in adverse health and economic consequences. Despite a multitude of studies, there are few well-controlled trials that assess interventions to improve compliance and outcomes. However, most experts concur on a series of educational and behavioral strategies that physicians can use to improve patient compliance with therapy. Consumer survey data indicate that some patients receive no information from their physicians when prescribed a new medication, and often the information provided is incomplete. The Guidelines for Physicians for Counseling Patients About Prescription Medications in the Ambulatory Setting were prepared to help physicians provide useful oral counseling and, when appropriate, written information about prescription medications that are prescribed for their patients in the ambulatory setting. These guidelines provide concise and useful recommendations in five key areas: the medication record, the treatment plan, oral counseling about the medication, written information about the medication, and follow-up. Published data on the value of patient medication cards are limited.

RECOMMENDATIONS included:

The AMA supports and will widely disseminate the Guidelines for Physicians for Counseling Patients About Prescription Medications in the Ambulatory Setting.  

The AMA encourages physicians to incorporate medication reviews, including discussions about drug interactions and side effects, as part of routine office-based practice, which may include the use of medication cards to facilitate this process. Medication cards should be regarded as a supplement, and not a replacement, for other information provided by the physician to the patient via oral counseling and, as appropriate, other written information.  

The AMA will continue to participate on the National Council on Patient Information and Education (NCPIE) to foster better medication use through improved communication between physicians and their patients, and the AMA encourages state and specialty medical societies to become members of NCPIE.

 

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