Medication Reconciliation in an Outpatient Geriatrics Clinic
Medication Reconciliation in an Outpatient Geriatrics Clinic
Although brown bag requests are common practice among geriatrics clinics and widely endorsed by and nurses, pharmacists, and clinicians, there are no standardized request instructions which then lead to wide variation in clinical practice. Studies assessing "brown bag" interventions reflect this heterogeneity, with some asking patients to "bring all of your medications" and others prompting specific medications, including non-oral medications, over-the-counter medications, and herbal supplements. The current study intentionally provided vague instructions because it is common practice in primary care settings. Consistent with other research, this pilot study suggests that patients who "brown bag" medications for office visit review may not bring every medication they report taking. Thus, provider-maintained chart lists may be no more accurate in BBs than NBBs. Medication lists generated at POC using semistructured interviews contain fewer inclusion and omission discrepancies among BBs than NBBs.
Study limitations include small sample size and single-site location, which reduces generalizability. Furthermore, bagging instructions were intentionally vague, in order to achieve a reasonable sample of NBBs, which led to patient self-selection bias.
All BBs perceived that their physicians reviewed their medications, compared with 62% of NBBs—a possible benefit of brown-bagging—although there were no differences in chart-recorded medication accuracy between BBs and NBBs. Furthermore, clinicians should not assume that their patients' "brown bags" are complete. This pilot study challenges the use of the "brown bag" practice alone to reconcile medications during routine care, unless coupled with specific instructions, in-depth questioning, and updating the medication list accordingly. Unfortunately, such comprehensive medication reviews are time-intensive and may not be practical during routine office visits.
Discussion
Although brown bag requests are common practice among geriatrics clinics and widely endorsed by and nurses, pharmacists, and clinicians, there are no standardized request instructions which then lead to wide variation in clinical practice. Studies assessing "brown bag" interventions reflect this heterogeneity, with some asking patients to "bring all of your medications" and others prompting specific medications, including non-oral medications, over-the-counter medications, and herbal supplements. The current study intentionally provided vague instructions because it is common practice in primary care settings. Consistent with other research, this pilot study suggests that patients who "brown bag" medications for office visit review may not bring every medication they report taking. Thus, provider-maintained chart lists may be no more accurate in BBs than NBBs. Medication lists generated at POC using semistructured interviews contain fewer inclusion and omission discrepancies among BBs than NBBs.
Study limitations include small sample size and single-site location, which reduces generalizability. Furthermore, bagging instructions were intentionally vague, in order to achieve a reasonable sample of NBBs, which led to patient self-selection bias.
All BBs perceived that their physicians reviewed their medications, compared with 62% of NBBs—a possible benefit of brown-bagging—although there were no differences in chart-recorded medication accuracy between BBs and NBBs. Furthermore, clinicians should not assume that their patients' "brown bags" are complete. This pilot study challenges the use of the "brown bag" practice alone to reconcile medications during routine care, unless coupled with specific instructions, in-depth questioning, and updating the medication list accordingly. Unfortunately, such comprehensive medication reviews are time-intensive and may not be practical during routine office visits.
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