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Research ArticleOriginal Research

A Randomized Controlled Trial of Two Interventions to Improve Medication Reconciliation

Caroline M. Wolff, Amy S. Nowacki, Jun-Yen Yeh and John M. Hickner
The Journal of the American Board of Family Medicine May 2014, 27 (3) 347-355; DOI: https://doi.org/10.3122/jabfm.2014.03.130240
Caroline M. Wolff
From the Northwestern University Family Medicine Residency, Chicago, IL (CMW); Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH (ASN); the Division of Pharmaceutical Sciences (J-YY), Long Island University, Brooklyn, NY; and the Department of Family Medicine (JMH) University of Illinois at Chicago.
MD
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Amy S. Nowacki
From the Northwestern University Family Medicine Residency, Chicago, IL (CMW); Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH (ASN); the Division of Pharmaceutical Sciences (J-YY), Long Island University, Brooklyn, NY; and the Department of Family Medicine (JMH) University of Illinois at Chicago.
PhD
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Jun-Yen Yeh
From the Northwestern University Family Medicine Residency, Chicago, IL (CMW); Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH (ASN); the Division of Pharmaceutical Sciences (J-YY), Long Island University, Brooklyn, NY; and the Department of Family Medicine (JMH) University of Illinois at Chicago.
BSPharm, MS, PhD
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John M. Hickner
From the Northwestern University Family Medicine Residency, Chicago, IL (CMW); Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH (ASN); the Division of Pharmaceutical Sciences (J-YY), Long Island University, Brooklyn, NY; and the Department of Family Medicine (JMH) University of Illinois at Chicago.
MD, MSc
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    Figure 1.

    Subjects were randomized to 1 of 4 study groups: no intervention (group A), printed medication list only (group B), open-ended question only (group C), and both interventions (group D).

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    Figure 2.

    Consort diagram describing the number of patients enrolled, randomized, and lost to follow-up and the number of patients completing the trial by study group.

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    Figure 3.

    Unadjusted medication list agreement for the 4 study groups showing the synergy between medical assistants' use of an open-ended question and patients' review of a printed medication list before seeing the physician.

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    Figure 4.

    Variation in agreement rates of the 20 physician/medical assistant (MD/MA) pairs.

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    Figure 5.

    Number and types of discrepancies by study group.

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    Table 1. Patient Demographics, Average Number of Medications Prescribed, and Literacy Levels of Patients in the 4 Study Groups
    Study GroupP Value*
    No Printed List and No Open-Ended Questiorn (n = 95)Printed List Only (n = 96)Open-Ended Question Only (n = 86)Printed List and Open-Ended Question (n = 90)
    Male sex (%)37423136.39
    Age (years)58.4 ± 13.957.6 ± 16.455.6 ± 18.159.6 ± 16.9.12
    Total items on list7.9 ± 5.48.2 ± 5.17.8 ± 4.58.9 ± 5.1.24
    Rx meds†5.3 ± 3.75.4 ± 4.35.1 ± 3.45.9 ± 3.6.25
    OTC medications‡0.9 ± 1.00.8 ± 0.80.9 ± 0.91.2 ± 1.2.16
    OTC other§1.8 ± 2.32.0 ± 2.01.8 ± 2.21.8 ± 2.2.95
    Follow-up rate (%)86877882.31
    Health literacy (“How confident are you filling out medical forms by yourself?”) (%).88
        High (“all or most of the time”)87878583
        Moderate (“sometimes”)7111110
        Low (“never”)7247
    • Data are mean ± standard deviation unless otherwise indicated.

    • ↵* These P values account for the clustering of patients within physician/medical assistant pairs.

    • ↵† Rx meds include any substance that requires a prescription.

    • ↵‡ OTC medications include any medication available over the counter (OTC) at an OTC strength.

    • ↵§ OTC other include any nonmedication available OTC at OTC strength.

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The Journal of the American Board of Family     Medicine: 27 (3)
The Journal of the American Board of Family Medicine
Vol. 27, Issue 3
May-June 2014
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A Randomized Controlled Trial of Two Interventions to Improve Medication Reconciliation
Caroline M. Wolff, Amy S. Nowacki, Jun-Yen Yeh, John M. Hickner
The Journal of the American Board of Family Medicine May 2014, 27 (3) 347-355; DOI: 10.3122/jabfm.2014.03.130240

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A Randomized Controlled Trial of Two Interventions to Improve Medication Reconciliation
Caroline M. Wolff, Amy S. Nowacki, Jun-Yen Yeh, John M. Hickner
The Journal of the American Board of Family Medicine May 2014, 27 (3) 347-355; DOI: 10.3122/jabfm.2014.03.130240
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Keywords

  • Medication Reconciliation
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