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Innovation Update

Engaging Veterans in Medication Reconciliation via Pharmacist-Mediated Secure Messaging

Medication discrepancies, defined as unintentional differences found between patients’ medical records and patients’ reports of medications they are taking, occur frequently after hospital discharge, predisposing patients to adverse drug events, emergency department (ED) visits, and readmissions.^1,2,3 Medication reconciliation is required at every care transition, yet high discrepancy rates after hospital discharge remain and suggest the need to develop strategies to ensure accurate and reliable medication data within the electronic health record. One innovative solution is to leverage online patient portals (e.g., myHealtheVet) that allow interactive, asynchronous electronic communication for review of medications. Thus, we developed an electronic tool for medication review, known as the Secure Messaging for Medication Reconciliation Tool (SMMRT).⁴

To test the effect of SMMRT, we conducted a randomized controlled trial among 240 Veterans hospitalized in one Veterans Affairs Medical Center. Participants were randomized to receive the SMMRT intervention (n=118) or usual care (n=122). Veterans in the SMMRT group were enrolled in myHealtheVet, trained to use both secure messaging and the SMMRT tool, and contacted by a clinical pharmacist to review medications and reconcile discrepancies in the two-week period following discharge.

Thirty days after discharge, fewer medication discrepancies occurred in the SMMRT group (4.4/person) than in the UC group (6.4/person; p<0.001), a 34 percent reduction. No between-group difference occurred in rates of the combined endpoint of 30-day readmissions and ED visits (SMMRT, 30% vs. UC, 34%; p=0.51).

An intervention to promote asynchronous medication review after hospital discharge reduced medication discrepancies by 34 percent but does not appear to reduce 30-day readmissions and ED visits. For patients with adequate computer literacy, asynchronous electronic communication may improve post-discharge patient safety. Additional forms of communication (e.g., mobile apps, text messaging) should be explored as potentially innovative mechanisms to improve the safety and quality of care provided to Veterans.

References

1. Nebeker, JR, Barach, P, Samore, MH. “Clarifying Adverse Drug Events: A Clinician’s Guide to Terminology, Documentation, and Reporting,” Annals of Internal Medicine 2004; 140(10):795-801.
2. Gandhi, TK, et al. “Adverse Drug Events in Ambulatory Care,” New England Journal of Medicine 2003; 348(16):1556-64.
3. Gandhi, TK, et al. “Drug Complications in Outpatients,” Journal of General Internal Medicine 2000; 15(3):149-54.
4. Heyworth, L, et al. “Engaging Patients in Medication Reconciliation via a Patient Portal following Hospital Discharge,” Journal of the American Medical Informatics Association 2013:amiajnl-2013-001995.