Accuracy of a Prescription Claims Database

11 Nov

medication reconciliation


Attention to patient safety in the hospital setting is increasing, largely because of the efforts of the US Institute for Healthcare Improvement’s 100,000 Lives campaign and the Safer Healthcare Now! initiative2 in Canada. Both of these programs include medication reconciliation as a priority topic, and many hospitals across North America have launched projects aimed at improving this process to meet accreditation standards. Medication reconciliation, defined as “a formal process of obtaining a complete and accurate list of each patient’s current home medications”, is now a requirement of the Canadian Council of Health Services Accreditation and a safety goal of the US Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations). However, in a recent Canadian study conducted in the emergency department of a large teaching hospital, medication reconciliation revealed a high rate of prescribing errors on admission, with serious health implications. The authors suggested that hospital access to prescription dispensation data from community pharmacies could help improve the accuracy of medication reconciliation.

PharmaNet is a provincial computer database that records medication information for all prescription transactions processed by British Columbia community pharmacies, regardless of patient age, payment method, or insurance coverage. It has been a legal requirement in British Columbia since 1995 that all prescriptions dispensed by community pharmacies be entered into the PharmaNet database for immediate adjudication of claims by the Ministry of Health. PharmaNet remains the most comprehensive prescription database in Canada, and it is used extensively in medication-related research and provincial drug policy decision-making. viagra plus

In 1999, access to PharmaNet was implemented in British Columbia hospitals for use by licensed pharmacists, and more recently for use by emergency physicians. Patient-specific PharmaNet profiles are reviewed to assist in obtaining medication histories and to identify drug-related problems related to medications taken before admission. However, patient interviews often reveal that patients have changed their medication regimens since the most recent refill of their prescriptions. As part of the Safer Healthcare Now! initiative, there has recently been a wide-scale systematic assessment of the medication reconciliation processes used in British Columbia hospitals. From these audits, it has become clear that printed PharmaNet profiles are often used in place of formal medication history interviews, despite the potential limitations of these profiles. Given that no published information on the accuracy of PharmaNet data is available and given that use of PharmaNet data for medication history information could lead to prescribing errors, we undertook a study to assess agreement between the prescription medication history obtained from PharmaNet and that obtained during a thorough patient interview. We hypothesized that the types and doses of prescription medications listed in PharmaNet would often be different from those actually being consumed by patients. It is anticipated that the information from this study will help those using PharmaNet for medication reconciliation as well those using PharmaNet data for research and policy decisions. It may also be useful for those accessing similar databases as they are implemented across Canada over the next few years.