Elevating the Role of Patient-Curated Med Lists in Meds Rec Processes

… based on data that I have recently been studying, patient-curated medication lists are more likely to be accurate than clinically-curated medication lists.

 

In my experience, the majority of clinicians don’t have a lot of respect for patient-curated medication lists.  I believe that a growing evidence base shows that this view is unfounded, and I want to explain why.

First let me say that I understand that many (perhaps most) patients aren’t interested in or don’t need to keep their own medication lists.  I get that.

But here’s the thing – when patients do keep their own medication lists, they are usually correct.  In fact, based on data that I have recently been studying (including de-identified data from the Australian National My Health Record), patient-curated medication lists are more likely to be accurate than clinically-curated medication lists.

I realise that’s a huge claim to make, and quite possibly a controversial one.  Unfortunately I’m not at liberty to disclose my data sources at this point, but I would like to attempt to explain why I think this is the case, and argue for stronger clinical consideration of patient-curated medication lists during medication reconciliation processes.

Fundamentally, when patients decide to keep a list of their own medications (and possibly related medication adherence information) they are intrinsically motivated.  They want to get well or stay well.  This is really important to them and their circle of care.  If they are not strongly motivated (and I’ve acknowledged that many aren’t, particularly people with poorer social determinants of health), they won’t create their own medication list in the first place.  It’s a self-selecting process.

By contrast, clinicians are extrinsically motivated, i.e. they are paid to curate patient health records.  As I’ve discussed in previous blog posts, intrinsic motivation is generally a stronger lever for behavioural change than extrinsic motivation.  Consequently, it should come as no great surprise that busy clinicians, who are paid under a fee-for-service model for appointments, but not explicitly (in Australia at least) paid for data quality, often don’t do a great job of this.  Now of course there are exceptions to this.  But I don’t want that to get in the way of my key observation – patients have a stronger motivation to capture their data correctly than clinicians do.

It’s also worth noting that clinicians don’t typically keep records of over the counter (OTC) medications, whereas patients tend to view their medications list as a whole, regardless of whether medications are prescribed or over the counter.  In a number of highly notable cases, this can be really important.  For example, St John’s Wort (an OTC medication), which is contra-indicated with the majority of prescription anti-depressants.  Not including OTCs in clinically-curated medication lists can therefore lead to avoidable adverse drug events.

The response to this should be simple.  I’m not arguing that patients should become the definitive source of health record data such as medication lists.  I’m arguing that respectively considering patient-curated medication lists as part of a medications reconciliation process is best practice.  We need to elevate the role of patient-curated medication lists.  The assumption that patients are incapable of keeping accurate data is paternalistic medicine at its worst.

 

3 Responses to“Elevating the Role of Patient-Curated Med Lists in Meds Rec Processes”

  1. Peter Jordan
    September 1, 2016 at 2:59 am #

    Ultimately, in the majority of cases, only the patient or direct care-giver can be the source of truth on the administration of medications, including the surrounding context plus any non-prescription items purchased ‘off-the-shelf. Certainly, prescribing and dispensing systems can present definitive views of those points in the medication ‘loop’, and ePrescription services can concatenate those two views – but they do not provide a complete picture. However, while many patients are capable of keeping accurate data, many are not. Only last night, I was in the back of an ambulance with an elderly relative who’d just suffered a nasty fall and could only recall half of the 12 medications contained on a prescribing list that I subsequently obtained from his GP. This may, or may not, be an ‘edge case’, but it does possibly highlight that it’s not just a question of evaluating the role of the patient, but also how that role might be fulfilled by those most in need, rather than the ‘worried well’.

    • admin
      September 1, 2016 at 3:09 am #

      Great points Peter. I’ve added a paragraph to reflect the OTC comments, which I omitted.

  2. December 26, 2016 at 8:17 pm #

    I used to work as a med recon pharmacy tech for a major university hospital in the US, and I appreciate this view. Here’s the problem: “When they (patient-curated med lists) are good, they are very, very good, but when they are bad, they are horrid.” I could regale you with any number of tales of (sometimes hilarious, sometimes frightening) misunderstandings and miscommunications. But another side of the problem is that we were perpetually behind by MONTHS on updating these lists, so the provider-curated lists were usually out of date (I understand that the system for tracking has changed in the 5 years since I’ve been gone, but I suspect it’s still virtually impossible for a team of techs to keep up with that much incoming data).

    I don’t think either system works and whether patient-curated or system-curated, the provider MUST look at the list critically, engage with the patient and ask plenty of questions.

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