title: Estimating the information gap between emergency department records of community medication compared to on-line access to the community-based pharmacy records.
abstract: OBJECTIVE
  Errors in community medication histories increase the risk of adverse events. The objectives of this study were to estimate the extent to which access to community-based pharmacy records provided more information about prescription drug use than conventional medication histories.
  
  
  METHODS
  A prospective cohort of patients with public drug insurance who visited the emergency departments (ED) in two teaching hospitals in Montreal, Quebec was recruited. Drug lists recorded in the patients' ED charts were compared with pharmacy records of dispensed medications retrieved from the public drug insurer. Patient and drug-related predictors of discrepancies were estimated using general estimating equation multivariate logistic regression.
  
  
  RESULTS
  613 patients participated in the study (mean age 63.1 years, 59.2% women). Pharmacy records identified 41.5% more prescribed medications than were noted in the ED chart. Concordance was highest for anticoagulants, cardiovascular drugs and diuretics. Omissions in the ED chart were more common for drugs that may be taken episodically. Patients with more than 12 medications (OR 2.92, 95% CI 1.71 to 4.97) and more than one pharmacy (OR 3.85, 95% CI 1.80 to 6.59) were more likely to have omissions in the ED chart.
  
  
  CONCLUSIONS
  The development of health information exchanges could improve the efficiency and accuracy of information about community medication histories if they enable automated access to dispensed medication records from community pharmacies, particularly for the most vulnerable populations with multiple morbidities.
  
  
  CONCLUSIONS
  Pharmacy records identified a substantial number of medications that were not in the ED chart. There is potential for greater safety and efficiency with automated access to pharmacy records.
authors: Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
authors: Robyn
authors: R
authors: Tamblyn
authors: Lise
authors: L
authors: Poissant
authors: Allen
authors: A
authors: Huang
authors: Nancy
authors: N
authors: Winslade
authors: Christian M
authors: CM
authors: Rochefort
authors: Teresa
authors: T
authors: Moraga
authors: Pamela
authors: P
authors: Doran
mesh_terms: D000328:Adult; D000368:Aged; D017723:Drug Utilization Review; D057286:Electronic Health Records; D055695:Electronic Prescribing; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D059065:Medication Reconciliation; D008510:Medication Systems, Hospital; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000627:therapeutic use; D010594:Pharmacies; D055553:Prescription Drugs / Q000627:therapeutic use; D011446:Prospective Studies; D011792:Quebec
chemical_list: D004366:Nonprescription Drugs; D055553:Prescription Drugs
keywords: community practice; electronic pharmacy records; medical informatics; medication reconciliation; patient safety
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