The Effectiveness of the Physician-Nurse-Pharmacist Collaboration Model in Medication Reconciliation Using National Health Insurance Pharmacloud in Ambulatory Care(2/3)

Medication safety is a global patient safety goal. Medication discrepancy is associated with the occurrence of adverse drug events (ADEs). Based on the study conducted in Taiwan, 8% of hospital new admissions had at least one mediation discrepancy and 19% of those medication discrepancies were associated with potentially medium to severe patient harm. In Taiwan, the occurrence of medication discrepancies in ambulatory care might be higher. Traditionally, patient’s medication history is taken and reviewed mainly relied on physicians, but in a busy setting like ambulatory care with high-volume patient visits, the physician usually has limited time for each patient. Little is known about the medication discrepancies in ambulatory care in Taiwan. Studies which discuss the role of the outpatient nurses in medication reconciliation in Taiwan are even fewer. Last year, the National Health Insurance PharmaCloud was released which physicians and pharmacists can review the patient’s prescription mediation regimens within the past three months. Therefore, aims of this study are to: 1). Explore the knowledge about medication discrepancies in ambulatory care; 2). Identify the characteristics of high-risk patients with medication discrepancies; 3). Investigate the physicians, nurses, and pharmacists’ knowledge, experience, and barriers of using PharmaCloud; 4). Develop an effective physician-nurse-pharmacist medication reconciliation program by using PharmaCloud in ambulatory care; and 5). Evaluate the effectiveness of the new physician-nurse-pharmacist medication reconciliation model in decreasing medication discrepancies. The proposed study will be a three-years study. Year one will be an exploratory study, 675 potentially eligible patients who meet the inclusion and exclusion criteria will be enrolled. Medication discrepancy tool (MDT) will be used to classify types of medication discrepancies as system-level or patient-level medication discrepancies. Descriptive statistics and logistic regression will be used to explore the occurrence, types, medication classes, contributing factors of medication discrepancies, specialist department with high number of medication discrepancies, and characteristics of high-risk patients. Year two is an exploratory study and to develop a new physician-nurse-pharmacist collaboration medication reconciliation model. Thirty physicians, nurses, and pharmacists (10 from each group) will be invited to investigate their knowledge, experience and barriers regarding medication reconciliation and the use of PharmaCloud in ambulatory care. Preliminary data from year one and year two will be used to modify medication reconciliation process using PharmaCloud. A pilot specialist department with medium number of medication discrepancies and medium-volume patient visits will be selected to test and modify the process of the new medication reconciliation. The third year will be a quasi-experimental, pre- and post-test study. Four hundred participants (200 patients in each experimental and control group) will be invited to evaluate the effectiveness of this new physician-nurse-pharmacist medication reconciliation program in decreasing medication discrepancies in ambulatory care. The outcomes of this study are to expand our understanding of medication discrepancies, to understand physicians, nurses, and pharmacists’ current knowledge, experience, and barriers of using PharmaCloud, to resolve the barriers of using PharmaCloud in order to develop an effective physician-nurse-pharmacist medication reconciliation program, and to evaluate the effectiveness of the new medication reconciliation program in decreasing medication discrepancies in ambulatory care. Those outcomes can increase the interdisciplinary collaboration and also enhance patients’ medication safety.