Physician adoption of medication reconciliation
The State of Qatar started its pursuit of establishing a comprehensive primary health care system in 1978, and since then all efforts have been made to enhance health care standards through primary health care services as the first line of defense.
Today, the Primary Health Care Corporation (PHCC) operates through 23 primary health care centers distributed among populated areas in all parts of the country. PHCC provides a wide variety of health care services that focus on maintenance of population health, prevention of diseases, and provision of a long-term and constant support to patients and their families.
In 2014, PHCC embarked on a journey to further improve the health care sector in the country through the implementation of a nationwide electronic health record system, with Cerner Millennium® at the core of such efforts.
Outpatient medication reconciliation is increasingly becoming a requirement for most hospital accreditation organizations due to its impact on maintaining the continuity of patient care across venues and health care organizations. In the case of PHCC and the State of Qatar, it is even more impactful since around 90 percent of patient records are stored on a single Cerner database with a high degree of patient movement across organizations.
By the final quarter of 2016, chart reviews revealed low adoption of outpatient medication reconciliation by PHCC physicians. In order to fully comply with the requirements of Accreditation Canada, ensure that patients’ medications lists reflected the correct active medication, reduce the frequency of drug-duplicate clinical decision support alerts, and hence avoid alert fatigue, the issue had to be clearly defined and rectified.
“PHCC planned to improve medication reconciliation as a requirement for patient safety and Canadian Accreditation. With the help of [Cerner’s PAE] we got a report on December 2016 that reconciliation is about four percent ...
We planned with [Cerner’s PAE] to re-train physicians and raise the awareness of the PHCC operation leads to the importance of medication reconciliation, ... [which lead] to the rise in reconciliation to about 50 percent within three months.
Appreciate the help of Cerner team ... to improve the reconciliation process and the continuity of the process.”
—Dr. Taha Abdel-Hameed Fahmy, physician SME, Primary Health Care Corporation
In order to clearly identify and quantify the issue at hand, Cerner’s physician alignment team in Qatar developed a detailed report to pull three months of data for all PHCC visits to examine the level of outpatient medication reconciliation adoption among all physicians. Between October and December 2016, the report found that out of 842,467 patients’ visits to PHCC’s 23 centers, only 3.1 percent had the medication list reconciled by physicians.
Accordingly, and working in close association with Cerner’s physician alignment team, the PHCC CIS team devised a plan to increase the uptake of outpatient medication reconciliation by physicians. Between January and March 2017, a campaign was conducted across the 23 centers to raise awareness to the importance of medication reconciliation to patient safety and continuity of care. The operation leads across all of PHCC were the first targets of the campaign. Raising their awareness and getting their buy-in set the plan off on the right track. With their support and utilizing Cerner’s reporting tools, physicians that showcased the highest opportunity for improvement were targeted for focused training sessions on the functionality and its importance. A series of similar training sessions took place targeting the next group with highest opportunity for improvement, and so on until the majority of physicians in each facility received the same training and showcased clear understanding.
In the three-month period following the campaign (April to June 2017), the same detailed report was utilized to gauge the impact of the interventional efforts. During the period, a total of 720,928 patients’ visits occurred in all PHCC centers, out of which 43.6 percent had the medication list reconciled by physicians. Analyzing the pre- and post-intervention data using the Chi-Square Test of Independence revealed a highly significant difference between the two groups (p < 0.001). The below figure presents the pre- and post-intervention data from the individual centers. The maximum pre-intervention medication reconciliation rate was 7.9 percent (Al Shamal Health Center). In the post-intervention period, the minimum rate was 21.6 percent, while the maximum was found in Leghwairiya Health Center at 82.3 percent, with an average rate across the 23 centers of 50.8 percent.