Improving the Effectiveness of Medication Review: Guidance from the Health Literacy Universal Precautions Toolkit

J Am Board Fam Med. 2016 Jan-Feb;29(1):18-23. doi: 10.3122/jabfm.2016.01.150163.

Abstract

Background: Although routine medication reviews in primary care practice are recommended to identify drug therapy problems, it is often difficult to get patients to bring all their medications to office visits. The objective of this study was to determine whether the medication review tool in the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit can help to improve medication reviews in primary care practices.

Methods: The toolkit's "Brown Bag Medication Review" was implemented in a rural private practice in Missouri and an urban teaching practice in California. Practices recorded outcomes of medication reviews with 45 patients before toolkit implementation and then changed their medication review processes based on guidance in the toolkit. Six months later we conducted interviews with practice staff to identify changes made as a result of implementing the tool, and practices recorded outcomes of medication reviews with 41 additional patients. Data analyses compared differences in whether all medications were brought to visits, the number of medications reviewed, drug therapy problems identified, and changes in medication regimens before and after implementation.

Results: Interviews revealed that practices made the changes recommended in the toolkit to encourage patients to bring medications to office visits. Evaluation before and after implementation revealed a 3-fold increase in the percentage of patients who brought all their prescription medications and a 6-fold increase in the number of prescription medications brought to office visits. The percentage of reviews in which drug therapy problems were identified doubled, as did the percentage of medication regimens revised.

Conclusions: Use of the Health Literacy Universal Precautions Toolkit can help to identify drug therapy problems.

Keywords: Education of Patients; Health Literacy; Medical Errors; Polypharmacy.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Attitude of Health Personnel
  • California
  • Communication
  • Electronic Health Records
  • Guideline Adherence / statistics & numerical data
  • Health Literacy*
  • Health Plan Implementation
  • Humans
  • Interviews as Topic
  • Medication Adherence / psychology
  • Medication Adherence / statistics & numerical data*
  • Medication Reconciliation / organization & administration
  • Medication Reconciliation / standards*
  • Medication Reconciliation / statistics & numerical data
  • Missouri
  • Office Visits
  • Organizational Case Studies
  • Patient Compliance / psychology
  • Patient Compliance / statistics & numerical data
  • Patient Education as Topic / methods
  • Patient Education as Topic / organization & administration
  • Patient Education as Topic / standards*
  • Physician-Patient Relations
  • Polypharmacy
  • Practice Guidelines as Topic
  • Primary Health Care / methods
  • Primary Health Care / organization & administration
  • Primary Health Care / standards*
  • Program Evaluation
  • Quality Assurance, Health Care / methods
  • Quality Assurance, Health Care / organization & administration
  • Quality Assurance, Health Care / standards*
  • Universal Precautions / methods