A mixed methods evaluation of medication reconciliation in the primary care setting

作者：Michael R. Gionfriddo, Vanessa Duboski, Allison Middernacht, Melissa Kern, Jove Graham, Eric A. Wright · 发表于：PLoS ONE · 年份：2021 · DOI：10.1371/journal.pone.0260882 · 被引用次数：21 · 研究领域：Pharmaceutical Practices and Patient Outcomes、Electronic Health Records Systems、Patient-Provider Communication in Healthcare

OBJECTIVES: To understand the extent to which behaviors consistent with high quality medication reconciliation occurred in primary care settings and explore barriers to high quality medication reconciliation. DESIGN: Fully mixed sequential equal status design including ethnographic observations, semi-structured interviews, and surveys. SETTING: Primary care practices within an integrated healthcare delivery system in the United States. PARTICIPANTS: We conducted 170 observations of patient encounters across 15 primary care clinics, 48 semi-structured interviews with staff, and 10 semi-structured interviews with patients. We also sent out surveys to 2,541 eligible staff with 616 responses (24% response rate) and to 5,132 eligible patients with 577 responses (11% response rate). RESULTS: Inconsistency emerged as a major barrier to effective medication reconciliation. This inconsistency was present across a variety of factors such as the lack of standardized workflows for conducting medication reconciliation, a lack of knowledge about medication and the process of medication reconciliation, varying levels of importance ascribed to medication reconciliation, and inadequate integration of medication reconciliation into clinical workflows. Findings were generally consistent across all data collection methods. CONCLUSION: We have identified several barriers which impact the process of medication reconciliation in primary care settings. Our key finding is that the process of medicati...