Pharmacies Often Still Dispense Meds Despite Discontinue Order
Findings among more than 30,000 patients treated at group practice with electronic health records
TUESDAY, Nov. 20 (HealthDay News) -- Despite electronic discontinuation orders, pharmacies may continue to dispense medications and create potential for patient harm, including situations with high-risk dispensing events, according to research published in the Nov. 20 issue of the Annals of Internal Medicine.
Adrienne S. Allen, M.D., M.P.H., from North Shore Physicians Group in Danvers, Mass., and Thomas D. Sequist, M.D., M.P.H., from Brigham and Women's Hospital in Boston, retrospectively assessed the rate of dispensing of discontinued medication among 30,406 adult patients with an electronic discontinuation order for anti-hypertensive, anti-platelet, anticoagulant, oral hypoglycemic, and statin medications (November 2008 to October 2009).
The researchers found that, among 83,902 targeted medications electronically discontinued, 1,218 (1.5 percent) were subsequently dispensed by the pharmacy a mean of 1.0 (standard deviation, 0.3) times during the year of follow-up. The rate of subsequent pharmacy dispensing ranged from a high of 2.5 percent for metoprolol to a low of 0.9 percent for metformin, among the top 10 most frequently electronically discontinued medications. An automated algorithm identified potential harm in 50 (12 percent) cases using manual chart review of 416 medication-dispensing events pre-defined as high-risk. Among the potential harms identified were clinical reactions (18), laboratory abnormalities (17), duplicated medication classes dispensed (eight), and potential allergic reactions (seven).
"The implementation of electronic health records have offered a clear opportunity to track when a clinician discontinues a medication, but now there needs to be a process that helps discontinued orders be transmitted electronically to the retail pharmacy," Allen said in a statement. "Future research should focus on evaluating methods of improving communication between providers and pharmacies to better reconcile medication lists, as well as explore strategies to improve patient knowledge and awareness of their medication regimen."