Dataset Information

Parents as partners in obtaining the medication history.

ABSTRACT:

Objective

Patient-centered information management may overcome barriers that impede high-quality, safe care in the emergency department (ED). The utility of parents' report of medication data via a multimedia, touch screen interface, the asthma kiosk, was investigated. Our specific aims were (1) to estimate the validity of parents' electronically entered medication history for asthma and (2) to compare the parents' kiosk entries regarding medications to the documentation of ED physicians and nurses.

Methods

We enrolled a cohort of parents to use the asthma kiosk and tested the validity of this communication channel for medication data specific to pediatric asthma. Parents' data provided via the kiosk during the ED encounter and the documentation of ED nurses and physicians were compared with a telephone-based interview with the parent after discharge that reviewed all asthma-specific medications physically present in the home. Treating clinicians in the ED were blinded to the parents' kiosk entries.

Results

Sixty-six parents were enrolled and 49 of 66 (74.2%) completed the gold standard interview. When analyzed at the level of individual medications, the validity of parental report was 81% for medication name, 79% for route of delivery, 66% for the form of the medication, and 60% for dose. Parents' report improved on the validity of documentation by physicians across all medication details save for medication name. Parents' report was more valid than nursing documentation at triage for all medication details.

Conclusion

Parents can provide an independent source of medication data that improves on current documentation for key variables that impact quality and safety in emergency asthma care.

SUBMITTER: Porter SC

PROVIDER: S-EPMC1090461 | biostudies-literature | 2005 May-Jun

REPOSITORIES: biostudies-literature

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Publications

Parents as partners in obtaining the medication history.

Porter Stephen C SC Kohane Isaac S IS Goldmann Donald A DA

Journal of the American Medical Informatics Association : JAMIA 20050131 3

<h4>Objective</h4>Patient-centered information management may overcome barriers that impede high-quality, safe care in the emergency department (ED). The utility of parents' report of medication data via a multimedia, touch screen interface, the asthma kiosk, was investigated. Our specific aims were (1) to estimate the validity of parents' electronically entered medication history for asthma and (2) to compare the parents' kiosk entries regarding medications to the documentation of ED physicians ...[more]

PMID: 15684127

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Project description:OBJECTIVES:In recent years, the involvement of pharmacy technicians in medication reconciliation has increasingly been investigated. The aim of this study was to assess the implications on professional roles and collaboration when a best possible medication history (BPMH) at admission is obtained by pharmacy technicians. DESIGN:Qualitative study with semistructured interviews. Data were analysed using a qualitative content analysis approach. SETTING:Internal medicine units in two mid-sized Swiss hospitals. PARTICIPANTS:21 staff members working at the two sites (6 pharmacy technicians, 2 pharmacists, 6 nurses, 5 physician residents and 2 senior physicians). RESULTS:Pharmacy technicians generally appreciated their new tasks in obtaining a BPMH. However, they also experienced challenges associated with their new role. Interviewees reported unease with direct patient interaction and challenges with integrating the new BPMH tasks into their regular daily duties. We found that pharmacists played a key role in the BPMH process, since they act as coaches for pharmacy technicians, transmit information to the physicians and reconcile preadmission medication lists with admission orders. Physicians stated that they benefitted from the delegation of administrative tasks to pharmacy technicians. Regarding the interprofessional collaboration, we found that pharmacy technicians in the study acted on a preliminary administrative level and did not become part of the larger treatment team. There was no direct interaction between pharmacy technicians and physicians, but rather, the supervising pharmacists acted as intermediaries. CONCLUSION:The tasks assumed by pharmacy technicians need to be clearly defined and fully integrated into existing processes. Engaging pharmacy technicians may generate new patient safety risks and inefficiencies due to process fragmentation. Communication and information flow at the interfaces between professional groups therefore need to be well organised. More research is needed to understand if and under which circumstances such a model can be efficient and contribute to improving medication safety.

Project description:BACKGROUND:Poor medication adherence is common and limits the effectiveness of treatment. OBJECTIVE:To investigate how social supports, automated alerts, and their combination improve medication adherence. DESIGN:Four-arm, randomized clinical trial with a 6-month intervention. PARTICIPANTS:A total of 179 CVS health employees or adult dependents with CVS Caremark prescription coverage, a current daily statin prescription, a medication possession ratio less than 80%, and Internet access. INTERVENTIONS:Participants were randomly assigned to control, social support (partner), automated adherence alert messages (alert), or both social support and alerts (partner?+?alert). Participants in the social support arms were asked to name a medication adherence partner (MAP) to help them take their medication. Participants in the alert arms were sent emails, text messages, or automated phone calls if they had failed to adhere on the previous day and on one or both of the 2 days before that. In partner?+?alert, both participants and fully enrolled MAPs received alerts. MAIN MEASURES:Adherence measured by wireless pill bottle opening. KEY RESULTS:Compared to 36.0% adherence in control, adherence was significantly greater in the alert arm (52.9%, difference vs. control of 17.0%, 95% CI for difference 6.3 to 27.6%, P?=?0.002) and the partner?+?alert arm (54.5%, difference vs. control of 18.6%, 95% CI for difference 6.6 to 30.5%, P?=?0.003). Adherence in the partner arm was not statistically significantly greater than control (43.2%, difference vs. control of 7.2%, 95% CI of difference -?5.2% to 19.5%, P?=?0.25). There were no statistically significant differences among the three treatment arms. Fewer participants invited a MAP in the partner?+?alert arm than the partner arm (P?=?0.02). CONCLUSIONS:Automated alerts were effective at improving medication adherence. Assigning a medication adherence partner did not statistically significantly affect adherence rates. TRIAL REGISTRATION:ClinicalTrials.gov Number NCT01890018 [ https://clinicaltrials.gov /].

Project description:IntroductionTeaching medication history taking or medication reconciliation to students requires practice for students to achieve competency. Practice makes students more confident with the process, but multiple practice opportunities require multiple cases, and creating these new cases can be a tedious and time-consuming process.MethodsThe Medication Mysteries Infinite Case Tool was designed to produce random patient cases using game-like features to allow students to practice medication history taking and medication reconciliation without the need to use and train standardized patients. The tool was created using a random draw card-based system to determine patient personality attributes, drugs they are taking, and confusions they have about their drug-taking behavior. This tool is used in a lab dedicated for the purpose of practicing medication history taking with students being assessed via simulation with standardized patients. This tool is currently used at the University of Florida College of Pharmacy as part of a training program for first-year pharmacy students.ResultsSince 2011, seven classes of first- and second-year pharmacy students have participated in this lab. Each year's class contained an average of 280 students divided into lab groups of 18-24 students. In our initial offering of the lab and assessment, 200 students on three campuses completed the individual assessments following the laboratory session. Fifty-eight percent achieved excellence, and 39% achieved competence on the individual assessment. Only 3% were assessed as being deficient on their performance and were required to repeat the assessment. Overall, 86.8% agreed or strongly agreed that the MMICT was an excellent way to experience how to reconcile medication.DiscussionStudents enjoy the practice and become proficient with the skills they learn through this process as evidenced by increased self-efficacy and achieved competence on a standardized assessment. The tool and the research associated with the outcome were awarded with the 2012 American Association of Colleges of Pharmacy Innovations in Teaching Award.

Project description:ObjectiveLow-cost evidence-based tools are needed to facilitate the early identification of patients with possible psychogenic nonepileptic seizures (PNES). Prior to accurate diagnosis, patients with PNES do not receive interventions that address the cause of their seizures and therefore incur high medical costs and disability due to an uncontrolled seizure disorder. Both seizures and comorbidities may contribute to this high cost.MethodsBased on data from 1,365 adult patients with video-electroencephalography-confirmed diagnoses from a single center, we used logistic and Poisson regression to compare the total number of comorbidities, number of medications, and presence of specific comorbidities in five mutually exclusive groups of diagnoses: epileptic seizures (ES) only, PNES only, mixed PNES and ES, physiologic nonepileptic seizurelike events, and inconclusive monitoring. To determine the diagnostic utility of comorbid diagnoses and medication history to differentiate PNES only from ES only, we used multivariate logistic regression, controlling for sex and age, trained using a retrospective database and validated using a prospective database.ResultsOur model differentiated PNES only from ES only with a prospective accuracy of 78% (95% confidence interval =72-84%) and area under the curve of 79%. With a few exceptions, the number of comorbidities and medications was more predictive than a specific comorbidity. Comorbidities associated with PNES were asthma, chronic pain, and migraines (p < 0.01). Comorbidities associated with ES were diabetes mellitus and nonmetastatic neoplasm (p < 0.01). The population-level analysis suggested that patients with mixed PNES and ES may be a population distinct from patients with either condition alone.SignificanceAn accurate patient-reported medical history and medication history can be useful when screening for possible PNES. Our prospectively validated and objective score may assist in the interpretation of the medication and medical history in the context of the seizure description and history.

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Dataset Information

Parents as partners in obtaining the medication history.

Objective

Methods

Results

Conclusion

Publications

Parents as partners in obtaining the medication history.

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