Transforming the Medication Regimen Review Process Using Telemedicine to Prevent Adverse Events

J Am Geriatr Soc. 2021 Feb;69(2):530-538. doi: 10.1111/jgs.16946. Epub 2020 Nov 24.


Background/objectives: Federally-mandated consultant pharmacist-conducted retrospective medication regimen reviews (MRRs) are designed to improve medication safety in nursing homes (NH). However, MRRs are potentially ineffective. A new model of care that improves access to and efficiency of consultant pharmacists is needed. The objective of this study was to determine the impact of pharmacist-led telemedicine services on reducing high-risk medication adverse drug events (ADEs) for NH residents using medication reconciliation and prospective MRR on admission plus ongoing clinical decision support alerts throughout the residents' stay.

Design: Quality improvement study using a stepped-wedge design comparing the novel service to usual care in a one-year evaluation from November 2016 to October 2017.

Setting: Four NHs (two urban, two suburban) in Southwestern Pennsylvania.

Participants: All residents in the four NHs were screened. There were 2,127 residents admitted having 652 alerts in the active period.

Intervention: Upon admission, pharmacists conducted medication reconciliation and prospective MRR for residents and also used telemedicine for communication with cognitively-intact residents. Post-admission, pharmacists received clinical decision support alerts to conduct targeted concurrent MRRs and telemedicine.

Measurement: Main outcome was incidence of high-risk medication, alert-specific ADEs. Secondary outcomes included all-cause hospitalization, 30-day readmission rates, and consultant pharmacists' recommendations.

Results: Consultant pharmacists provided 769 recommendations. The intervention group had a 92% lower incidence of alert-specific ADEs than usual care (9 vs 31; 0.14 vs 0.61/1,000-resident-days; adjusted incident rate ratio (AIRR) = 0.08 (95% confidence interval (CI) = 0.01-0.40]; P = .002). All-cause hospitalization was similar between groups (149 vs 138; 2.33 vs 2.70/1,000-resident-days; AIRR = 1.06 (95% CI = 0.72-1.58); P = .75), as were 30-day readmissions (110 vs 102; 1.72 vs 2.00/1,000-resident-days; AIRR = 1.21 (95% CI = 0.76-1.93); P = .42).

Conclusions: This is the first evaluation of the impact of pharmacist-led patient-centered telemedicine services to manage high-risk medications during transitional care and throughout the resident's NH stay, supporting a new model of patient care.

Keywords: adverse drug events; clinical decision support; medication errors; nursing home; telemedicine.

Publication types

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

MeSH terms

  • Aftercare* / methods
  • Aftercare* / standards
  • Aftercare* / statistics & numerical data
  • Aged
  • Decision Support Systems, Clinical
  • Drug-Related Side Effects and Adverse Reactions / prevention & control*
  • Female
  • Homes for the Aged / standards*
  • Humans
  • Male
  • Medication Reconciliation* / methods
  • Medication Reconciliation* / trends
  • Medication Therapy Management / standards
  • Models, Organizational
  • Nursing Homes / standards*
  • Pharmacists
  • Professional Role
  • Quality Improvement
  • Telemedicine / methods*