J Am Med Inform Assoc - Estimating the information gap between emergency department records of community medication compared to on-line access to the community-based pharmacy records.

Tópicos

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Resumo

JECTIVE: 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.

Resumo Limpo

jectiv error communiti medic histori increas risk advers event object studi estim extent access communitybas pharmaci record provid inform prescript drug use convent medic historiesmateri method prospect cohort patient public drug insur visit emerg depart ed two teach hospit montreal quebec recruit drug list record patient ed chart compar pharmaci record dispens medic retriev public drug insur patient drugrel predictor discrep estim use general estim equat multivari logist regressionresult patient particip studi mean age year women pharmaci record identifi prescrib medic note ed chart concord highest anticoagul cardiovascular drug diuret omiss ed chart common drug may taken episod patient medic ci one pharmaci ci like omiss ed chartdiscuss develop health inform exchang improv effici accuraci inform communiti medic histori enabl autom access dispens medic record communiti pharmaci particular vulner popul multipl morbiditiesconclus pharmaci record identifi substanti number medic ed chart potenti greater safeti effici autom access pharmaci record

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