Transforming the Medication Regimen Review Process Using Telemedicine to Prevent Adverse Events

Area of Science:

• Geriatric Pharmacy
• Health Services Research
• Telemedicine

Background:

• Federally-mandated retrospective medication regimen reviews (MRRs) in nursing homes (NHs) aim to enhance medication safety but may be ineffective.
• A need exists for improved access and efficiency of consultant pharmacist services.
• This study addresses the limitations of traditional MRRs by exploring a novel care model.

Purpose of the Study:

• To evaluate the impact of pharmacist-led telemedicine services on reducing high-risk medication adverse drug events (ADEs).
• To assess the effectiveness of medication reconciliation and prospective MRR on admission, coupled with ongoing clinical decision support.
• To determine the utility of this model throughout a resident's stay in a NH.

Main Methods:

• A quality improvement study employed a stepped-wedge design over one year.
• The study compared a novel pharmacist-led telemedicine service with usual care in four NHs.
• Intervention included admission medication reconciliation, prospective MRR, and telemedicine, with post-admission clinical decision support alerts for targeted reviews.

Main Results:

• The intervention group experienced a 92% lower incidence of alert-specific ADEs compared to usual care (AIRR = 0.08).
• No significant differences were observed in all-cause hospitalization or 30-day readmission rates between the groups.
• Consultant pharmacists provided 769 recommendations throughout the study period.

Conclusions:

• Pharmacist-led telemedicine services effectively manage high-risk medications during transitional care and ongoing NH stays.
• This represents a novel patient-centered model for improving medication safety in NH residents.
• The findings support the integration of telemedicine to enhance consultant pharmacist services.