Patient, physician, medical assistant, and office visit factors associated with medication list agreement

Objectives: Despite its importance for patient safety, there have been few studies of medication reconciliation in primary care. Our goal was to identify potential patient, physician, medical assistant (MA), and office visit factors associated with accurate medication lists in Cleveland Clinic primary care practices. Methods: Physician and MA medication reconciliation activities were directly observed during office visits. The primary outcomewas agreement between the electronic medical record medication list at the conclusion of the office visit and what the patients said they were actually taking, assessed by structured telephone interview within 2 weeks of the office visit. Medication list agreement was defined as the absence of any discrepancies in name, dose, frequency, route, and as-needed status. Associations between patient, physician,MA, and office visit factors and medication list accuracy were assessed using ρ² tests and logistic regression. Results: Twenty-four physicians and 33 MAs were observed during 231 patient encounters. Nineteen patients (8%) could not be contacted for the telephone interview and were excluded from the analysis. Thirty-two patients (15%) had perfect medication list agreement for prescription and nonprescription medications, and 66 patients (31%) had medication list agreement for prescription medications only. Of the 14 patient, physician, and MA medication reconciliation behaviors examined, only 1, in which the MA begins the medication review with an open-ended question, was significantly associated with a medication list in agreement (odds ratio, 2.96; confidence interval, 1.43-6.09) for prescription and nonprescriptionmedications. This association was not significant when only prescription medications were included (odds ratio, 0.90; confidence interval, 0.43-1.91). No behaviors we observed significantly influenced prescription medication list agreement. Conclusions: HavingMAs begin their medication review with an openended question may be a simple, inexpensive, and easily implemented process to increase accuracy of medication lists for prescription and nonprescription medications.