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Published on: January 26, 2019
Medication Discrepancies in Older Veterans Receiving Home Healthcare
Amanda S Mixon1, Heidi Poppendeck, Sunil Kripalani
1Amanda S. Mixon, MD, MS, MSPH, FHM, is a Research Physician, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System; Assistant Professor of Medicine, Section of Hospital Medicine, Vanderbilt University Medical Center; Core Faculty, Vanderbilt Center for Clinical Quality and Implementation Research; and Faculty, Vanderbilt Center for Health Services Research, Nashville, Tennessee. Heidi Poppendeck, MPH, is a Research Assistant, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System; and a Research Assistant, Vanderbilt Center for Health Services Research, Nashville, Tennessee. Sunil Kripalani, MD, MSc, is a Professor of Medicine, Section of Hospital Medicine, Vanderbilt University Medical Center; Director, Vanderbilt Center for Clinical Quality and Implementation Research; Faculty, Vanderbilt Center for Health Services Research; and Collaborator, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee. Theodore Speroff, PhD, MS, is Director of Health Services Research, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System; and Faculty, Vanderbilt Center for Health Services Research, Nashville, Tennessee. John Schnelle, PhD, is a Research Scientist, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System; Core Faculty, Vanderbilt Center for Clinical Quality and Implementation Research; Faculty, Vanderbilt Center for Health Services Research; and Former Director, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee. Robert Dittus, MD, MPH, is Director, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System; Core Faculty, Vanderbilt Center for Clinical Quality and Implementation Research; and Faculty, Vanderbilt Center for Health Services Research, Nashville, Tennessee. Christianne Roumie, MD, MPH, is a Research Physician, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System; Core Faculty, Vanderbilt Center for Clinical Quality and Implementation Research; and Faculty, Vanderbilt Center for Health Services Research, Nashville, Tennessee.
Abstract:
In a prospective cohort study of Veterans and community health nurses, we enrolled hospitalized older Veterans referred to home care for skilled nursing and/or physical or occupational therapy for posthospitalization care. We assessed preadmission activities of daily living and instrumental activities of daily living, health literacy, numeracy, and cognition. Postdischarge phone calls identified medication errors and medication reconciliation efforts by home healthcare clinicians. Veterans Administration-based community health nurses completed surveys about content and timing of postdischarge interactions with home healthcare clinicians. We determined the types and frequency of medication errors among older Veterans receiving home healthcare, patient-provider communication patterns in this setting, and patient characteristics affecting medication error rates. Most Veterans (24/30, 80%) had at least one discordant medication, and only one noted that errors were identified and resolved. Veterans were asked about medications in the home healthcare setting, but far fewer were questioned about medication-taking details, adherence, and as-needed or nonoral medications. Higher numeracy was associated with fewer errors. Veterans Administration community health nurses reported contact by home healthcare clinicians in 41% of cases (7/17). Given the high rate of medication errors discovered, future work should focus on implementing best practices for medication review in this setting, as well as documenting barriers/facilitators of patient-provider communication.
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