Transforming the Medication Regimen Review Process Using Telemedicine to Prevent Adverse Events
© 2020 The American Geriatrics Society..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:69 |
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| Enthalten in: |
Journal of the American Geriatrics Society - 69(2021), 2 vom: 01. Feb., Seite 530-538 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kane-Gill, Sandra L [VerfasserIn] |
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| Links: |
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| Themen: |
Adverse drug events |
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| Anmerkungen: |
Date Completed 17.09.2021 Date Revised 17.09.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/jgs.16946 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM31799736X |
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| 245 | 1 | 0 | |a Transforming the Medication Regimen Review Process Using Telemedicine to Prevent Adverse Events |
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| 500 | |a Date Completed 17.09.2021 | ||
| 500 | |a Date Revised 17.09.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 The American Geriatrics Society. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a SETTING: Four NHs (two urban, two suburban) in Southwestern Pennsylvania | ||
| 520 | |a PARTICIPANTS: All residents in the four NHs were screened. There were 2,127 residents admitted having 652 alerts in the active period | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, U.S. Gov't, P.H.S. | |
| 650 | 4 | |a adverse drug events | |
| 650 | 4 | |a clinical decision support | |
| 650 | 4 | |a medication errors | |
| 650 | 4 | |a nursing home | |
| 650 | 4 | |a telemedicine | |
| 700 | 1 | |a Wong, Adrian |e verfasserin |4 aut | |
| 700 | 1 | |a Culley, Colleen M |e verfasserin |4 aut | |
| 700 | 1 | |a Perera, Subashan |e verfasserin |4 aut | |
| 700 | 1 | |a Reynolds, Maureen D |e verfasserin |4 aut | |
| 700 | 1 | |a Handler, Steven M |e verfasserin |4 aut | |
| 700 | 1 | |a Kellum, John A |e verfasserin |4 aut | |
| 700 | 1 | |a Aspinall, Monica B |e verfasserin |4 aut | |
| 700 | 1 | |a Pellett, Megan E |e verfasserin |4 aut | |
| 700 | 1 | |a Long, Keith E |e verfasserin |4 aut | |
| 700 | 1 | |a Nace, David A |e verfasserin |4 aut | |
| 700 | 1 | |a Boyce, Richard D |e verfasserin |4 aut | |
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