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

Authors Kogut S, Goldstein E, Charbonneau C, Jackson A, Patry G

Received 25 October 2013

Accepted for publication 29 November 2013

Published 17 January 2014 Volume 2014:6 Pages 1—6

DOI https://doi.org/10.2147/DHPS.S56574

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3


Stephen Jon Kogut,1 Elaina Goldstein,1 Camille Charbonneau,1 Anita Jackson,1 Gail Patry2

1Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, 2Healthcentric Advisors, Providence, RI, USA

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


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