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Patterns and predictors of medication discrepancies in primary care
Author(s) -
Coletti Daniel J.,
Stephanou Hara,
Mazzola Nissa,
Conigliaro Joseph,
Gottridge JoAnne,
Kane John M.
Publication year - 2015
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12387
Subject(s) - medicine , health literacy , multivariate analysis , medical record , regimen , family medicine , medline , health care , physical therapy , political science , law , economics , economic growth
Rationale, aims and objectives Identifying medication discrepancies across transitions of care is a common patient safety problem. Research examining relations between medication discrepancies and adherence, however, is limited. The objective of this investigation is to explore the relations between adherence and patient–provider medication discrepancies, and to test the hypothesis that non‐adherence would be associated with medication discrepancies. Methods Three hundred twenty‐eight outpatients completed a current medication list and measures of health literacy, adherence, perceived physical functioning and subjective well‐being. Patient lists were compared with active medications in the electronic medical record. Multivariate analyses identified demographic, clinical and patient‐reported variables associated with discrepancies involving prescribed daily medications. Results Despite high rates of self‐reported adherence, patients reported taking fewer medications than the number of active medications in their medical record (3.79 vs. 4.83, P < 0.001). We identified one or more discrepancies in most records (294/328 or 89.6%). Identified discrepancies were completely reconciled in only 21.1% of patients with discrepancies. Discrepancies were associated with lower health literacy, poorer physical health status and subjective well‐being, and poorer adherence to the regimen patients believed they had been prescribed. Multivariate analysis indicated that the number of medical record‐reported medications and subjective well‐being independently predicted the presence of discrepancies. Conclusions Findings suggest a complex relation between treatment adherence and medication discrepancies in which patient well‐being and regimen complexity work in tandem to create discordance between patient and provider medication plans. Simplifying regimens when possible and attending to patient life satisfaction may improve adherence to a regimen constructed jointly between patient and provider.