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QUALITY


Taking control TMA develops medication reconciliation tool


BY AMY LYNN SORREL When Garland family physician Clifford T. Fullerton, MD, gave one of his elderly patients a printed summary of her visit that included a list of all of the medica- tions she needed to manage various conditions, her reaction took him by surprise. Tears welled up in the woman’s eyes. “She felt so much more in control to have that information — what she was taking and why she was taking it,” he said. “Having that list relieved a lot of confusion she had. We [phy- sicians] forget how second nature this is to us and how foreign it is to patients.” The approach may be simple. But with more patients managing chronic diseases and a broad push to improve care coordination and reduce health care costs, medica- tion reconciliation is that much more critical, physician leaders say. According to a study by the Agency for Healthcare Research and Quality, drug-related ad- verse outcomes were recorded in 838,000 emergency department visits (1 percent of all visits) and 1.9 million hospitalizations (5 per- cent of all stays) in 2008, costing roughly $2.6 billion. Medication reconciliation also is a recognized component of patient safety the Joint Commission incorporated into its National Patient Safety Goals. Yet, until today’s health care system is fully integrated, pri-


mary care physicians, specialists, and pharmacists aren’t al- ways able to talk to each other in real time, nor can electronic medical record (EMR) systems communicate with one another. Dr. Fullerton knows physicians could use a tool to stand in the gap. He leads the Patient-Centered Medical Home Initiative at HealthTexas, a multispecialty physician network at Baylor Health Care System in Dallas, where he also is vice president of the Chronic Disease Institute.


“The form is a patient


engagement and patient safety tool all in one.”


Dr. Fullerton says a medication list “is probably the single most helpful piece of information a patient and physician can have because it frequently indicates the active problems the patient has.” It’s important because of the potential risks of medication interactions and because patients may land in the emergency department, hospital, or a physician’s office with- out a primary care history. To help avoid those risks and encourage patients to get in- volved in their own care, Dr. Ful- lerton and fellow members of the Texas Medical Association Council on Health Care Quality created a medication reconciliation tool with support from the Texas Medical Li- ability Trust. The tool is the latest in a suite of quality improvement resources the council is develop- ing. (See “Investing in Prevention,” June 2013 Texas Medicine, pages 39–42.) The “Personal Emergency and Medication Record” is a standard- ized, paper-based form a physi- cian office can use to help patients track their medicines and record their primary care and emergency contacts in one place. Physicians can keep a record on file, patients can fold it up to fit in their wal- let, and parents can give it to their children’s schools.


“The form is a patient engagement and patient safety tool all in one,” said TMA Director for Clinical Quality Joseph Y. Gave. The tool is free and downloadable from the TMA website at www.texmed.org/ClinicalQualityTools/.


Getting patients involved Patients’ health status can frequently change, and so can their medications, which is why the form has a place for patients to record not only the type of drugs they take, but also the dos- age, frequency, and reason.


July 2013 TEXAS MEDICINE 49


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