Evaluation of the Primary Care Reimbursement Services data as a
Transcription
Evaluation of the Primary Care Reimbursement Services data as a
Evaluation of the Primary Care Reimbursement Services data as a source of pre-admission medication information Grimes T.1,2, Fitzsimons M.1, Galvin M.3, Delaney T.4, Flanagan S.4 1Adelaide and Meath Hospital, inc. the National Children’s Hospital, Dublin; 2School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin; 3Naas General Hospital, Kildare; 4Health Services Executive. Admission Reconcile Pre-admission medication list (PAML) Inpatient prescribing What medication did the patient ACTUALLY use before admission? The Gold Standard PAML (GS-PAML) Discharge prescribing The challenge • 400,000 emergency inpatient discharges • 39% total inpatients aged 65+ years – ESRI HIPE Annual Report 2009 • Polypharmacy is common in older persons – Ryan C et al., Br J Clin Pharm 2010 • Increasing multimorbidity – Mercer SW et al., Family Practice, 2009 • Advances in preventative medicine Pre-Admission Medication (PAM) Information • Availability and reliability of sources of PAM info • Setting: Two acute, public hospitals • Study design: Observational study • Study sample: Random selection of adults, admitted via A&E, using 3+ meds • Data management: SPSS®, version 15 • Feb to May 2009 Fitzsimons M., et al. Drug Utilisation and Research Group, UK and Ireland, London, 2010 1. Patient interview 3. Patient corroboration 2. External corroboration •General Practitioner – verbal •GP referral letter •Community Pharmacist – verbal •Patient’s own drugs (PODs) •Nursing home list •Nursing home – verbal •Inpatient Kardex (previous 6/12) •Inpatient summary (previous 6/12) •PCRS data Gold Standard Pre-Admission Med List 4. Compare Primary Care Reimbursement Services (PCRS) • General Medical Services (GMS) scheme – aka Medical card holders • Centralised records • Retrospective review of PCRS dispensed records • Research question: • Do PCRS dispensed records provide reliable PAM information for medical card patients? • How does this compare to other sources of information? Findings • 134 patients recruited to original study • 97 (72%) patients with GMS medical cards • 92 of 97 identified on PCRS system • 90 of 92 had medication dispensed under the GMS Scheme during the study period Factor A Source Potential for use B C Availability Agree with No. Of disagreement per episode GS-PAML (mean) n(%) n(%) n(%) Grading Rank A*(B+C) 134 (100) 132 (99) 49 (37) 3.3 136 1 Community pharmacy 134 (100) 126 (94) 21 (17) 2.5 111 2 Patient/ carer PCRS 97 (72) 90 (93) 15 (17) 2.9 79 3 GP surgery 134 (100) 88 (66) 9 (10) 3.3 76 4 Inpatient Kardex 50 (37) 34 (68) 2 (6) 4.8 27 5 POD 134 (100) 58 (43) 2 (3) 4.6 46 6 GP referral letter 53 (40) 42 (79) 1 (2) 6.2 32 7 Discharge summary 50 (37) 29 (58) 1 (3) 6.9 23 8 NH staff 9 (7) 9 (100) 8 (89) 0.2 13 9 NH list 9 (7) 6 (67) 1 (17) 1.7 6 10 Types of disagreement PCRS Discharge summary Kardex NH staff NH list Omission Commission POD Dose/ Frequency Other GP letter GP surgery CP Patient/ carer 0% 20% 40% 60% Percentage of disagreements 80% 100% Strengths & Limitations • Small sample size • Two study sites • Random sampling Conclusions • For medical card holders – Similar degree of agreement with GS-PAML as Community Pharmacy – Avoid interruptions to primary care clinicians • Future work – Explore opportunities and challenges to make PCRS data available in the hospital setting Agreement of sources with GS-PAML Per medication Mean # disagreement s per episode Per episode Agreement Frequency n (%) N Frequency n (%) N Patient/ carer 49 37.1 132 960 68.4 1403 3.4 POD 2 3.4 58 350 56.7 617 4.6 GP letter 1 2.4 42 189 44.1 456 6.2 GP surgery 9 10.2 88 656 69.3 946 3.3 Comm’ Pharm’ 21 16.7 126 1025 76.8 1334 2.5 Inpt kardex 6/12 2 5.9 34 262 61.5 426 4.8 DCS 6/12 1 3.4 29 191 48.8 391 6.9 NH list 1 16.7 6 89 89.9 99 1.7 NH staff 8 88.9 9 125 98.4 127 0.2 PCRS GMS 15 16.7 90 757 74.1 1021 2.9