Communication About Medications in Chronic Illness
Communication About Medications in Chronic Illness
The main findings from this study demonstrate that there are opportunities for improvement in terms of the review that clients receive pertaining to their medications, the level of communication between physicians and clients, the access clients have to physicians and the use of technology related to providing a port for communication. In examining the findings, there are some limitations that are inherent in conducting a secondary analysis of pre-existing survey data. Due to the nature of the data, there was an inability to further explore the characteristics of the communities and hospitals in which the errors occurred. As well, the use of the secondary data set did not permit the opportunity to ask specific questions of interest or to clarify any findings. Another potential limitation of the study was the reliance on self-reported error reporting. Research demonstrates that medication errors are under-reported, which presents a challenge as it is difficult to know the exact number of errors during this study period. Additionally, the survey asked participants to reflect retrospectively, presenting the opportunity for recall bias. Nonetheless, the survey and database provided valid, reliable and in-depth data that covered a broad geographical range and a large sample size.
The results from this study identified that many of the adults with chronic medical conditions were taking numerous medications concurrently. Previous research has identified that when clients are taking five or more medications there is an increase in the likelihood of a self-reported medication error occurrence. Moreover, only 783 (29.7%) of clients identified that they always had their medications reviewed and discussed by a physician or pharmacist within the last 2 years. When physicians were asked if they provided their clients with a written list of medications they were taking, nearly half (44%) indicated they did not. Therefore, these results indicate that 24.9 % of participants are taking more than 5 medications and appear to not be receiving adequate monitoring and follow up. These results are concerning given that adults with chronic illness access the health care system frequently, have more long-term interactions with physicians and other health care professionals, tend to be on multiple medications, and tend to see a greater number of physicians, with all of these characteristics putting them at greater risk of error.
When physicians were asked if they call clients to check on medications, symptoms or help coordinate care in between visits with other staff such as nurses, nurse practitioners, medical assistants, 15% of respondents indicated they do not do this. As such, there is a need to foster improved communication amongst team members. Furthermore, the client needs to be seen as an integral team member.
Although communication is an area that is taught in most medical programs, discussing medications with clients is an area that needs to be emphasized and frequently revisited during physician/client encounters.
There is a greater risk of experiencing a medication error at points in transition of care. This is especially true for clients who have a chronic disease. In this study, 637 (24.2%) clients leaving the hospital identified they had been given a new prescription and 194 (7.4%) said that no one had discussed what to do with other medications they were taking prior to being hospitalized. There is a lack of standardization regarding transfer of accountability in Canadian hospitals, with the risk of miscommunication increasing when a person is transitioning between care providers. Clients should be encouraged to keep a list of their medications with them, including name, strength, dose and frequency of dosage, names of all non-prescription medicines, vitamins and herbal products, known medication and food allergies, special diets, and medications previously taken and the rationale for discontinuation.
Although the majority of clients found it somewhat to very easy to contact their physician's office, 594 (22%) indicated they found it somewhat to very difficult. Furthermore, this variable only captured the ability to contact the physician's office, and not necessarily the physician directly. Access is a top concern of Canadians about the health care system. Problems accessing their physicians are likely to send clients to seek other medical assistance. Data shows that when clients have multiple care providers and are on multiple medications, there is a higher risk for experiencing medication errors. A health care poll conducted by Harris interactive found that 90% of online Americans would like to be able to access their physician by email. However, the majority of physicians are not reimbursed for time and risk association with advice dispensed through email or phone.
Email communication between clients and physicians was also found to be low, with only 166 (6.3%) of client indicating they communicate in this manner. Given that younger individuals are typically more technologically savvy, there is an opportunity for clients to connect with physicians via e-technology that is not currently being fully realized. In 1998, email exchange between physicians and clients was seen as an opportunity to provide improved communication and increase client involvement in their own care. Given the prevalence of computer usage in physician offices, a lack of email communication is not readily understood. Many physicians may still feel uncomfortable using information technology. However, effective communication has been shown to improve client satisfaction, recall of information, and medical outcomes, and can protect physicians against malpractice litigation.
Beyond email, other technological advances such as e-prescribing and electronic transfer of prescriptions were not well used by physicians. Illegible handwriting has been identified as a cause of medication errors. Insufficient information has been identified as a significant cause of medication errors. Information technology is envisioned to be integral to advancing quality in health care.
The results from this study uphold the findings from the Institute of Medicine, that identified steps to reduce medication errors, namely to encourage clients to take an active role in their health care and the greater use of technology. Therefore, there is a role for health care leaders to advocate for clients taking an increased role in their care and increased use of technology.
Recommendations to improve client safety, health care quality, and to reduce risk to patients due to poor communication from the perspective of the health care providers include: (a) Healthcare providers need to be trained to recognize how cultural differences, socio-economic factors, and personal values and beliefs can impact, both positively and negatively, effective communication; (b) Healthcare providers should be introduced to the concept of normative deviance, and how this 'drifting into failure' behavior may be negatively impacting their client-provider relationship; (c) Advances in communicative technology (particularly email) should be embraced and offered to clients who are technologically competent; (d) Healthcare providers should be trained on how to effectively facilitate client centered care appointments; (e) Systematic changes are needed in how high risk situations, such as transfer of care, are dealt with; and (f) Medication use and communication in the community setting needs to be thoroughly assessed and studied to provide support for all of the changes recommended above. Responsibility to improve communication rests not only with health care providers, but also with the patient. Recommendations for how patients should communicate with their health care providers include: (a) Carrying an up to date list of medications with them to all appointments; (b) Requesting an update list of medications from their health care provider at the transition in care, such as discharge from hospital; (c) Knowing the medication they are on and the rational for each medication; (d) Bringing a list of questions and concerns to all appointments; (e) Reporting any changes to their medication regime that their care provider may not be aware of (such as the use of herbal remedies); (f) Request a follow up appointment when a change in their medication regime has been made and (g) Accurately reporting the frequency of which they are taking their medications, any side effects they are experiencing and advocating and/or challenging any changes in their medication regime.
Discussion
The main findings from this study demonstrate that there are opportunities for improvement in terms of the review that clients receive pertaining to their medications, the level of communication between physicians and clients, the access clients have to physicians and the use of technology related to providing a port for communication. In examining the findings, there are some limitations that are inherent in conducting a secondary analysis of pre-existing survey data. Due to the nature of the data, there was an inability to further explore the characteristics of the communities and hospitals in which the errors occurred. As well, the use of the secondary data set did not permit the opportunity to ask specific questions of interest or to clarify any findings. Another potential limitation of the study was the reliance on self-reported error reporting. Research demonstrates that medication errors are under-reported, which presents a challenge as it is difficult to know the exact number of errors during this study period. Additionally, the survey asked participants to reflect retrospectively, presenting the opportunity for recall bias. Nonetheless, the survey and database provided valid, reliable and in-depth data that covered a broad geographical range and a large sample size.
The results from this study identified that many of the adults with chronic medical conditions were taking numerous medications concurrently. Previous research has identified that when clients are taking five or more medications there is an increase in the likelihood of a self-reported medication error occurrence. Moreover, only 783 (29.7%) of clients identified that they always had their medications reviewed and discussed by a physician or pharmacist within the last 2 years. When physicians were asked if they provided their clients with a written list of medications they were taking, nearly half (44%) indicated they did not. Therefore, these results indicate that 24.9 % of participants are taking more than 5 medications and appear to not be receiving adequate monitoring and follow up. These results are concerning given that adults with chronic illness access the health care system frequently, have more long-term interactions with physicians and other health care professionals, tend to be on multiple medications, and tend to see a greater number of physicians, with all of these characteristics putting them at greater risk of error.
When physicians were asked if they call clients to check on medications, symptoms or help coordinate care in between visits with other staff such as nurses, nurse practitioners, medical assistants, 15% of respondents indicated they do not do this. As such, there is a need to foster improved communication amongst team members. Furthermore, the client needs to be seen as an integral team member.
Although communication is an area that is taught in most medical programs, discussing medications with clients is an area that needs to be emphasized and frequently revisited during physician/client encounters.
There is a greater risk of experiencing a medication error at points in transition of care. This is especially true for clients who have a chronic disease. In this study, 637 (24.2%) clients leaving the hospital identified they had been given a new prescription and 194 (7.4%) said that no one had discussed what to do with other medications they were taking prior to being hospitalized. There is a lack of standardization regarding transfer of accountability in Canadian hospitals, with the risk of miscommunication increasing when a person is transitioning between care providers. Clients should be encouraged to keep a list of their medications with them, including name, strength, dose and frequency of dosage, names of all non-prescription medicines, vitamins and herbal products, known medication and food allergies, special diets, and medications previously taken and the rationale for discontinuation.
Although the majority of clients found it somewhat to very easy to contact their physician's office, 594 (22%) indicated they found it somewhat to very difficult. Furthermore, this variable only captured the ability to contact the physician's office, and not necessarily the physician directly. Access is a top concern of Canadians about the health care system. Problems accessing their physicians are likely to send clients to seek other medical assistance. Data shows that when clients have multiple care providers and are on multiple medications, there is a higher risk for experiencing medication errors. A health care poll conducted by Harris interactive found that 90% of online Americans would like to be able to access their physician by email. However, the majority of physicians are not reimbursed for time and risk association with advice dispensed through email or phone.
Email communication between clients and physicians was also found to be low, with only 166 (6.3%) of client indicating they communicate in this manner. Given that younger individuals are typically more technologically savvy, there is an opportunity for clients to connect with physicians via e-technology that is not currently being fully realized. In 1998, email exchange between physicians and clients was seen as an opportunity to provide improved communication and increase client involvement in their own care. Given the prevalence of computer usage in physician offices, a lack of email communication is not readily understood. Many physicians may still feel uncomfortable using information technology. However, effective communication has been shown to improve client satisfaction, recall of information, and medical outcomes, and can protect physicians against malpractice litigation.
Beyond email, other technological advances such as e-prescribing and electronic transfer of prescriptions were not well used by physicians. Illegible handwriting has been identified as a cause of medication errors. Insufficient information has been identified as a significant cause of medication errors. Information technology is envisioned to be integral to advancing quality in health care.
The results from this study uphold the findings from the Institute of Medicine, that identified steps to reduce medication errors, namely to encourage clients to take an active role in their health care and the greater use of technology. Therefore, there is a role for health care leaders to advocate for clients taking an increased role in their care and increased use of technology.
Recommendations to improve client safety, health care quality, and to reduce risk to patients due to poor communication from the perspective of the health care providers include: (a) Healthcare providers need to be trained to recognize how cultural differences, socio-economic factors, and personal values and beliefs can impact, both positively and negatively, effective communication; (b) Healthcare providers should be introduced to the concept of normative deviance, and how this 'drifting into failure' behavior may be negatively impacting their client-provider relationship; (c) Advances in communicative technology (particularly email) should be embraced and offered to clients who are technologically competent; (d) Healthcare providers should be trained on how to effectively facilitate client centered care appointments; (e) Systematic changes are needed in how high risk situations, such as transfer of care, are dealt with; and (f) Medication use and communication in the community setting needs to be thoroughly assessed and studied to provide support for all of the changes recommended above. Responsibility to improve communication rests not only with health care providers, but also with the patient. Recommendations for how patients should communicate with their health care providers include: (a) Carrying an up to date list of medications with them to all appointments; (b) Requesting an update list of medications from their health care provider at the transition in care, such as discharge from hospital; (c) Knowing the medication they are on and the rational for each medication; (d) Bringing a list of questions and concerns to all appointments; (e) Reporting any changes to their medication regime that their care provider may not be aware of (such as the use of herbal remedies); (f) Request a follow up appointment when a change in their medication regime has been made and (g) Accurately reporting the frequency of which they are taking their medications, any side effects they are experiencing and advocating and/or challenging any changes in their medication regime.
