“This helps patients become more literate about their own health, and a lack of health literacy is very expensive.”
have multiple purposes. Wellbutrin (bu- propion), for instance, can be prescribed for depression or for smoking cessation, so physicians might think a patient is de- pressed, when he or she is trying to quit smoking. Certain seizure medications can be used to treat chronic pain. Knowing why a patient is taking a particular drug “can make a big differ- ence in how you manage that patient,” Dr. Fullerton said.
Filling the gaps
While the form is designed largely for practices that rely on a paper-based chart system, even those using EMRs can benefit.
As with Dr. Fullerton’s elderly patient, that last piece of information can be especially helpful in getting patients to comply with doctors’ orders if they fully understand why they are taking a drug. “It turns the focus to the patients and helps keep them at the center of what we are doing,” he said. Armed with the information, patients can better evalu- ate whether they really need a particular pain medication, for example, or remind themselves to discuss their cholesterol at their next primary care visit. The tool targets any patients taking multiple medications who do not other- wise have a way to track them. But it particularly can benefit those
with chronic conditions, whose health status can frequently change and for whom a drug regimen is critical to im- proving care, says San Antonio infectious disease specialist Jan Ellen Patterson, MD, also a member of TMA’s Council on
Health Care Quality. Patients receive a similar form upon discharge from the hospitals and veterans clinics affiliated with The University of Texas Health Sci- ence Center at San Antonio, where she is associate dean for quality and lifelong learning.
“This helps patients become more lit- erate about their own health, and a lack of health literacy is very expensive,” she said. “If people don’t understand why they are taking a medication and the dose, they end up coming back [to the hospital] within 30 days of leaving, and care becomes inefficient and expensive. That’s especially true for patients with chronic conditions like heart and lung disease, who are at high risk” for com- plications.
Clifford T. Fullerton, MD
Jan Ellen Patterson, MD
50 TEXAS MEDICINE July 2013
Such a tool can also better equip phy- sicians to manage their patients’ care and foster patient safety. More often than not, patients show up in the emergency department or are admitted to the hospital without a re- cord of the medications they take. If a patient’s medications change upon re- lease, “that information doesn’t always get back to the primary care physician,” Dr. Patterson said, adding that a writ- ten list of patients’ current medications could prevent that information from fall- ing through the cracks and help avoid unintended drug interactions. On top of that, some medications
Unless practices are hooked up to a formal health information exchange, such as through a medical home collab- orative or accountable care organization (ACO), the digital records can’t “talk” to each other, i.e., share information among different practices or hospitals. Dr. Fullerton uses his EMR to record his patients’ medications. But if a patient seeks care from a specialist, such as a cardiologist or a surgeon, that specialist can’t see his notes.
Nor is communication among various
care settings completely streamlined. Patients may see a subspecialist with- out notifying the physician of their cur- rent medications or without alerting their primary care physician to any ad- ditional prescriptions, for example. Ide- ally, the subspecialist writes a letter to the primary care physician explaining the treatment, Dr. Patterson says. But if that particular primary care physician did not refer the patient, he or she may not get that notice.
TMA leaders emphasize the impor- tance of having patients regularly update the medication reconciliation form. Dos- es may change, for example. And physi- cians may have a record in the chart of what they prescribed, but patients may not actually be taking that drug if they didn’t follow through on filling a pre- scription or if the pharmacy filled the order with something else. Dr. Patterson also recommends doc-
tors instruct patients to record any non- prescription drugs they use, as well. These days, more patients are taking
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