Estimating the information gap between emergency department records of community medication compared to on-line access to the community-based pharmacy records

J Am Med Inform Assoc. May-Jun 2014;21(3):391-8. doi: 10.1136/amiajnl-2013-001704. Epub 2013 Aug 16.

Abstract

Objective: Errors in community medication histories increase the risk of adverse events. The objectives of this study were to estimate the extent to which access to community-based pharmacy records provided more information about prescription drug use than conventional medication histories.

Materials and methods: A prospective cohort of patients with public drug insurance who visited the emergency departments (ED) in two teaching hospitals in Montreal, Quebec was recruited. Drug lists recorded in the patients' ED charts were compared with pharmacy records of dispensed medications retrieved from the public drug insurer. Patient and drug-related predictors of discrepancies were estimated using general estimating equation multivariate logistic regression.

Results: 613 patients participated in the study (mean age 63.1 years, 59.2% women). Pharmacy records identified 41.5% more prescribed medications than were noted in the ED chart. Concordance was highest for anticoagulants, cardiovascular drugs and diuretics. Omissions in the ED chart were more common for drugs that may be taken episodically. Patients with more than 12 medications (OR 2.92, 95% CI 1.71 to 4.97) and more than one pharmacy (OR 3.85, 95% CI 1.80 to 6.59) were more likely to have omissions in the ED chart.

Discussion: The development of health information exchanges could improve the efficiency and accuracy of information about community medication histories if they enable automated access to dispensed medication records from community pharmacies, particularly for the most vulnerable populations with multiple morbidities.

Conclusions: Pharmacy records identified a substantial number of medications that were not in the ED chart. There is potential for greater safety and efficiency with automated access to pharmacy records.

Keywords: community practice; electronic pharmacy records; medical informatics; medication reconciliation; patient safety.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Drug Utilization Review
  • Electronic Health Records*
  • Electronic Prescribing
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Medication Errors / prevention & control
  • Medication Reconciliation*
  • Medication Systems, Hospital*
  • Middle Aged
  • Nonprescription Drugs / therapeutic use
  • Pharmacies*
  • Prescription Drugs / therapeutic use
  • Prospective Studies
  • Quebec

Substances

  • Nonprescription Drugs
  • Prescription Drugs