Access to Medical Records' Impact on Community Pharmacist–Delivered Medication Therapy Management: A Pilot From the Medication Safety Research Network of Indiana (Rx-SafeNet).

Gernant, Stephanie A.; Zillich, Alan J.; Snyder, Margie E.

Background: Medication therapy management (MTM) may be optimized if pharmacists engaged in health information exchange (HIE) by reviewing unedited medical records. Methods: In this nonblinded, randomized, controlled pilot, pharmacists delivered a part of MTM, comprehensive medication reviews (CMRs), to adult patients in a practice-based research network (PBRN). Intervention community pharmacists solicited the last 6 months of patients' primary care provider-held, unedited medical records. The primary and secondary outcomes were the number of medication-related problems (MRPs) and preventive care omissions identified. The intervention was analyzed via Mann-Whitney U test and multivariate linear regression models. Pharmacists were surveyed regarding the available health history's helpfulness in CMR delivery. Results: Thirty-seven patients received CMRs across the 2 groups. Intervention pharmacists (n = 4) identified significantly more MRPs (median = 11 vs 6; B = 6.98, 95% confidence interval [CI]: 0.005-13.96; P = .049) and omissions in preventive care (24% vs 17%; B = 2.78, 95% CI: 0.46-5.10; P = .009) than usual care pharmacists (n = 3). Intervention pharmacists were more likely to agree they were confident they identified all of the patient's MRPs (47.1% vs 15.8%), but neither group was more likely than the other to believe they had resolved all MRPs (41.2% vs 42.1%). Finally, intervention pharmacists agreed 100% of the time that the available health history helped them complete a better CMR, compared with only 69% of usual care pharmacists. Conclusion: In this pilot, community pharmacists identified more MRPs and omissions in preventive care when they reviewed unedited medical records. Larger studies are warranted to determine whether HIE can improve outcomes.

COMMUNITY health services; CONFIDENCE intervals; DRUGS; ELECTRONIC data interchange; MEDICAL history taking; MEDICAL records; MULTIVARIATE analysis; HEALTH outcome assessment; PHARMACISTS; PREVENTIVE health services; REGRESSION analysis; SURVEYS; PILOT projects; RANDOMIZED controlled trials; MEDICATION therapy management; MANN Whitney U Test

Journal of Pharmacy Practice, 2018, Vol 31, Issue 6, p642

0897-1900

Academic Journal

10.1177/0897190017735422