Effects of a pharmacy-driven medication history program on patient outcomes.

PURPOSE: Obtaining an accurate medication history is a vital component of medication reconciliation upon admission to the hospital. Despite the importance of this task, medication histories are often inaccurate and/or incomplete. We evaluated the association of a pharmacy-driven medication history initiative on clinical outcomes of patients admitted to the general medicine service of an academic medical center. METHODS: Comparing patients who received a pharmacy-driven medication history to those who did not, a retrospective stabilized inverse probability treatment weighting propensity score analysis was used to estimate the average treatment effect of the intervention on general medical patients. Fifty-two patient baseline characteristics including demographic, operational, and clinical variables were controlled in the propensity score model. Hospital length of stay, 7-day and 30-day unplanned readmissions, and in-hospital mortality were evaluated. RESULTS: Among 11,576 eligible general medical patients, 2,234 (19.30%) received a pharmacy-driven medication history and 9,342 (80.70%) patients did not. The estimated average treatment effect of receiving a pharmacy-driven medication history was a shorter length of stay (mean, 5.88 days vs 6.53 days; P = 0.0002) and a lower in-hospital mortality rate (2.34% vs 3.72%, P = 0.001), after adjustment for differences in patient baseline characteristics. No significant difference was found for 7-day or 30-day all-cause readmission rates. CONCLUSION: Pharmacy-driven medication histories reduced length of stay and in-hospital mortality in patients admitted to the general medical service at an academic medical center but did not change 7-day and 30-day all-cause readmission rates. Further research via a large, multisite randomized controlled trial is needed to confirm our findings.

The role of race, ethnicity, and language in care transitions.

OBJECTIVES: To identify areas where transition from hospital to community could be improved, with a special focus on racial, ethnic, and language differences. STUDY DESIGN: A cross-sectional survey administered by postal mail and bilingual telephone interviewers. METHODS: Patients were randomly selected within strata by race, ethnicity, and language proficiency. A total of 224 patients (response rate: 63.5%) who had recently experienced a hospital stay completed the survey. RESULTS: Overall, 1 in 4 patients were alone at discharge. More than half of patients with limited English proficiency reported lack of access to medical interpreters and translated materials. We noted significant differences by race, ethnicity, and language in technology access and in patient-reported worries in the posthospital period. Hispanic or Latino patients and patients with limited English proficiency were less likely to report access to a computer and less likely to access the Patient Gateway portal. Black or African American patients were also less likely to use the Patient Gateway portal. Asian patients were more likely to be worried about getting home health services. CONCLUSIONS: Our findings highlight the enhanced difficulties that diverse patients may experience when transitioning from hospital to community-based settings. When considering how to best address the complex needs of diverse populations, interventions must be sensitive to the presence or absence of others, potential digital divides, and medical interpretation.

Correlation of Provider Burnout With Patient Experience.

Initiatives to mitigate physician burnout and improve patient experience occur largely in isolation. At the level of the department/division, we found lower physician burnout was associated with a more positive patient experience. Physician Maslach Burnout Inventory data and patient Consumer Assessment of Healthcare Providers and Systems Clinician and Group experience scores were significantly correlated with 5 of 12 patient experience questions: "Got Routine Care Appointment" (-0.632, P = .001), "Recommend Provider" (-0.561, P = .005), "Provider Knew Medical History" (-0.532, P = .009), "Got Urgent Care Appointment" (-0.518, P = .014), and "Overall Rating" (-0.419, P = .047). These correlations suggest burnout and experience might be better addressed in tandem. Principles to guide an integrated approach are suggested.

Nurses' attitudes to single checking medications: before and after its use.

We report nurses' attitudes towards the single checking of medications before and after the implementation of this procedure in an acute health-care setting. Data from a pre-implementation survey confirmed that some nurses held strong views against single checking. Following this survey, the hospital's medication administration policy was revised, a single checking resource manual was developed, 1-2 h nurse education sessions were held, the competencies of nurses to single check and to administer medications were assessed, and single checking was successfully piloted before hospital-wide implementation. Data from a survey conducted 18 months after the implementation indicated that nurses welcomed the single checking medication procedure, felt more confident using single checking and perceived that it made them more accountable for administering medications. The findings provide evidence that nurses' attitudes to single checking change remarkably in favour of its use with education and experience using this procedure.