Comparison of the Completeness of Prescription Medication Histories: DISCUSSION
The results of the current study suggest that pharmacists may obtain more complete histories of a patient’s use of prescription medication than other health care workers. However, because the variability in the data was large, the difference was not statistically significant. Since taking medication histories is a focus of pharmaceutical care, pharmacists may spend more time obtaining medication information than other health care professionals. Also, pharmacists likely have a broader knowledge of available pharmacy products, which enables them to pose more specific drug-related questions during a patient interview.
Results from several previous studies suggest that pharmacists obtain more accurate medication histories than physicians. However, it is difficult to define a preferred standard for comparison. Badowski and others attempted to assess this issue by validating a questionnaire on simulated patients. In the validation study, pharmacists obtained 100% of the information about prescription and nonprescription medications from the simulated patients, whereas physicians obtained 79% of the information about prescription drugs and 45% of that about nonprescription drugs. Once validated, pharmacists used the questionnaire for 80 newly admitted medical and surgical patients, and their results were compared with the medication histories documented by physicians. Pharmacists obtained at least one additional piece of information for 95% of patients. At least 2 studies have concluded that information about medication histories that physicians miss is clinically important. cialis 10 mg
The results from the current study suggest that a computer prescription database is a valuable tool for obtaining medication histories, but that information about medication histories should not be limited to one resource. As assessed in this study, the use of PharmaNet did not seem to influence pharmacists’ identification of the proportion of medications taken before admission. In the authors’ experience, patients often start and stop medications, contrary to written prescriptions, with or without the advice of the prescriber. For example, patients may take medications they have left over from previous personal prescriptions, or they may take medication prescribed for other family members. Specific questioning during an interview may be the only way of revealing this type of behaviour. A prescription database may not, therefore, accurately reflect the number of medications a patient is taking. On the other hand, patients for whom PharmaNet was reviewed in the current study took more medications before admission to hospital, suggesting that pharmacists spent the extra time to review PharmaNet only for patients with more complex medical histories. This potential selection bias makes a comparison between groups for whom PharmaNet was reviewed or not reviewed difficult, and likely contributed to the higher number of drug-related problems identified for PharmaNet patients.
The unique information available in PharmaNet may also have contributed to its greater identification of drug-related problems. For example, the PharmaNet profile can be used to identify prescription medications that patients do not mention during an interview. Accordingly, the most common type of drug-related problem identified with the use of PharmaNet was an untreated indication. Previous research19 has identified that seniors’ underuse of beneficial drug therapy is associated with increased morbidity, mortality, and reduced quality of life. Further, PharmaNet provides detailed dosing information. Dosing issues were amongst the most common drug-related problems identified when PharmaNet was reviewed. PharmaNet can also be useful for assessing medication adherence through a comparison of refill rates and quantity issued.
canadian drugstore online
PharmaNet was used for only 11% of the 52 patients randomly selected from the charts from the Medical Records Department. No formal policy exists within the St Paul’s Hospital Pharmacy Department specifying which patients should be seen by a pharmacist for a thorough medication history or when PharmaNet should be used. When it was used, PharmaNet was not accessed for an average of almost 4 days after the patient was admitted to hospital. This may have been because reviewing PharmaNet was considered too time- consuming for routine use at the time of admission and was done only when specific details of the patient’s history suggested it might be useful.
