Improving medication management after a hospitalization with pharmacist home visits and electronic personal health records: an observational study

Abstract

Background

Substantial opportunity exists to improve medication management in the period following a hospital discharge. The objective of this study was to assess and improve medication management during care transitions through pharmacist home visits and the use of an electronic personal health record (ePHR) system.

Methods

Recently discharged patients aged 50 years or older and having a chronic medical condition were offered the opportunity to meet with a pharmacist in the home setting to review medication instructions and receive a demonstration of an ePHR system. Patients agreeable to using the ePHR system were offered pharmacist support with setting up the ePHR system, having emphasis on documenting and reviewing medication regimens. Medication-related problems identified by the pharmacist during the visit were categorized according to ePHR use and by other characteristics.

Results

Thirty recently discharged patients with chronic disease were visited by a pharmacist over a 6-month period. The percentage of medication-related problems identified by the pharmacist was greater among those patients who agreed to use the ePHR system, as compared with patients whose visit did not include use of the ePHR (75% versus 40%, respectively; P=0.06). Differing types of medication-related problems were identified, including therapy duplications, lack of use of clinically important therapies, and patient nonadherence.

Conclusion

For some patients, the home setting can be a suitable venue for medication review and education after discharge from hospital. Assisting patients with setting up the ePHR system may enhance pharmacists’ ability to identify and resolve medication-related problems that may lead to rehospitalization.

Keywords:

• medication reconciliation
• care transition
• electronic personal health record

Acknowledgments

This work was funded by a grant from the Center for Technology and Aging, which sponsored the Tech4Impact program (Technologies for Improving Post-Acute Care Transitions) to advance the use of technologies that improve care transitions and reduce avoidable hospitalizations. Funding was also provided through a Rhode Island State Legislative grant to support application of the ePHR program (ER-Card) in promoting care quality among Rhode Island seniors. The authors are grateful for the review and instructive comments provided by Kevin M Ryan, University of Rhode Island, and by David Lindeman and Valerie Steinmetz from the Center for Technology and Aging.

Disclosure

The researchers did not receive funding from any pharmaceutical manufacturer in relation to this work. The authors report no other conflicts of interest in this work.