| 1. To what extent are behaviors indicative of a best possible medication history (BPMH) for medication reconciliation adhered to in a primary care setting? |
Average adherence to behaviors consistent with a BPMH was 53% and ranged from 33% to 82%. Adherence to individual behaviors were also variable ranging from 2% to 100%. Notable findings include: |
| • OTC medications were asked about by 36% of observed staff |
| • Medication name was asked 99% of the time while dose was confirmed only 41% of the time |
| • Staff asked if the patient was taking any new medications 17% of the time |
| 2. What are the barriers which inhibit the accurate completion of medication reconciliation? Do these barriers differ between patients and staff or between staff with and without prescribing authority? |
We found that inconsistency was a major driver of poor medication reconciliation and identified several barriers including: |
| • Lack of a standardized workflow. This contributed to a lack of clarity around who is responsible for medication reconciliation and lack of comfort around conducting medication reconciliation. |
| • Lack of knowledge. This included lack of knowledge about how to conduct proper medication reconciliation as well as lack of knowledge about medications (for both patients and staff) |
| • Variable importance of medication. While both staff and patients recognized the importance of having an accurate medication list, importance varied based on the type of medication being addressed with prescription medications generally viewed as more important than non-prescription medications. |
| • Inadequate integration into clinical workflows. Staff noted that collecting medication information and entering medications into the electronic health record was difficult within the current workflows especially for non-prescription medications and existing workflows did not set aside adequate time to properly conduct medication reconciliation. |
| • Certain barriers affecting the completion of medication reconciliation did differ between prescribers and non-prescribers (e.g., time), while others (e.g., knowledge) did not. |
| 3. What changes do patients and staff think can be made to improve the process of medication reconciliation in primary care? |
Based on data from both patients and staff we identified several opportunities for improvement including: |
| • Staff training and patient education |
| • Reminders for patients to bring in medications lists/bottles and for staff to ask about all medications |
| • Workflow redesign and standardization (including guidelines) |
| • EHR redesign |
| • Increased time for medication reconciliation or designated visits to conduct medication reconciliation. |
