Communicating about medications during primary care outpatient visits: the role of electronic medical records.
OBJECTIVE
To assess the role of electronic medical records (EMR) in facilitating the content and process of patient-provider exchanges about medications during outpatient primary care visits.


METHODS
Fifty encounters with six physicians using the EMR were videotaped, transcribed and content-analysed by applying conversation analysis and ethnomethodology techniques. The analysis focused on three aspects of medication communication: (1) process of care: practices by patients and physicians to implement medication decisions; (2) themes: medication topics that consistently emerge; and (3) names: ways patients and physicians refer to medications. In-depth analysis of 20 encounters examined the extent to which either or both parties initiated, expanded and concluded medication discussions.


RESULTS
On average 21.2 (range: 8-35; SD=7.4) distinct exchanges per encounter were observed. Of those, 33% were related to medication. Of the 350 medication-related exchanges throughout the encounters, 56% were categorised as routine medication discussion such as ordering and/or refilling medications. Mailing issues were the next most common medication-related exchanges (10.6%), followed by partial adherence (8.9%), self-regulation (7.4%), alternative therapy/over-the-counter medication (6.6%), side effects (6%) and formulary issues (4.6%). Patients and providers used three ways to name medications: generic/scientific name (42%); physical description (39.7%) and brand name (18.3%). Forty-one percent of exchanges included initiation by one or both parties but no further discussion of the issue; 42% included initiation and expansion by both parties but not conclusion; only 17% of exchanges contained complete medication exchanges (initiation, expansion and conclusion) by both parties.


CONCLUSIONS
EMR facilitated content and process of communication regarding medications during outpatient encounters, especially among patients taking multiple medications and patients who used physical descriptions to identify their medications. EMR use stimulated medication exchanges, leading to further expansion about the topic. However, fewer than one-fifth of exchanges ended with clear conclusions by both parties regarding prescribed medication regimens.
Arar
Nedal H
NH
Veterans Evidence-based Research Dissemination Implementation Center/Audie L Murphy Memorial Veterans Hospital and University of Texas Health Science Center at San Antonio, South Texas Veterans Health Care System, TX 78229-4404, USA. ararn@uthscsa.edu
Wen
Lonnie
L
McGrath
John
J
Steinbach
Rebecca
R
Pugh
Jacqueline A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D004358:Drug Therapy; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010349:Patient Compliance; D010817:Physician-Patient Relations; D011320:Primary Health Care; D017064:Process Assessment, Health Care; D013781:Texas